title: HIV women's health: a study of gynecological healthcare service utilization in a U.S. urban clinic population.
abstract: BACKGROUND
  Women infected with HIV have a high rate of many gynecological problems. Adherence to recommended gynecological care among women enrolled in our urban HIV clinics was hypothesized to be low.
  
  
  METHODS
  We conducted an analysis of data from the Johns Hopkins HIV Clinical Cohort Database examining demographic and clinical predictors of clinic visit adherence by women in the HIV primary care and HIV gynecological clinics.
  
  
  RESULTS
  Between January 2002 and April 2006, 1,086 women had 26,401 scheduled appointments to the two clinics, of which 21,959 were to HIV primary care and 4,442 were to HIV gynecological care. There were 12,097 (55%) completed primary care visits and 1,609 (36.2%) completed HIV gynecological visits (p < 0.001, accounting for clustering). By multivariate analysis, age <40 years (OR 0.81, 95% CI 0.70-0.94) and substance abuse (OR 0.67, 95% CI 0.61-0.73) were associated with a decreased likelihood of attending an HIV primary care appointment. African American race (OR 0.63, 95% CI 0.45-0.90), CD4 count <200 cells/mm(3) (OR 0.73, 95% CI 0.56-0.95), and substance abuse (OR 0.57, 95% CI 0.45-0.71) were associated with a decreased likelihood of attending an HIV gynecological appointment.
  
  
  CONCLUSIONS
  This analysis determined that the rate of clinic visit adherence is significantly lower for HIV gynecological care than for HIV primary care in the same population of women. Factors associated with HIV gynecological clinic visit noncompliance included African American race/ethnicity, substance use, and more advanced immunosuppression. We have planned additional quantitative and qualitative studies to examine the associations with and barriers to HIV gynecological care, with the goal of creating appropriate interventions toward improving gynecological healthcare utilization among women enrolled in urban HIV clinics.
authors.affiliation: Department of Medicine, Division of General Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. mtello@partners.org
authors.forename: Monique A
authors.initials: MA
authors.lastname: Tello
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.forename: Jean M
authors.initials: JM
authors.lastname: Keller
authors.forename: Mary C
authors.initials: MC
authors.lastname: Beach
authors.forename: Jean R
authors.initials: JR
authors.lastname: Anderson
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011247:Pregnancy; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D016387:Women's Health