title: Associations of rural residence with timing of HIV diagnosis and stage of disease at diagnosis, South Carolina 2001-2005.
abstract: BACKGROUND
  Rural areas in the southern United States face many challenges, including limited access to health care services and stigma, which may lead to later HIV diagnosis among rural residents.
  
  
  OBJECTIVE
  To investigate the associations of rural residence with timing of HIV diagnosis and stage of disease at diagnosis.
  
  
  METHODS
  Timing of HIV diagnosis was categorized as a diagnosis of acquired immune deficiency syndrome within 1 year of a first positive HIV test or HIV-only. Stage of disease was based on initial CD4+ T-cell count taken within 1 year of diagnosis. County of residence at HIV diagnosis was classified as urban if the population of the largest city was at least 25,000; it was classified as rural otherwise. Logistic regression was used to analyze timing of HIV diagnosis, and analysis of covariance was used to analyze stage of disease.
  
  
  RESULTS
  From 2001 to 2005, 4,137 individuals were diagnosed with HIV infection. Of these, 1,129 (27%) were rural and 3,008 (73%) were urban residents. Among rural residents, 533 (47%) were diagnosed late, compared with 1,258 (42%) urban residents. Rural residents were significantly more likely to be diagnosed late (OR 1.19 [95% CI, 1.02-1.38]). Rural residence was associated with lower initial CD4+ T-cell count in crude analysis (P= .01) but not after adjustment (P > .05).
  
  
  CONCLUSIONS
  Rural residence is a risk factor for late HIV diagnosis. This may lead to reduced treatment response to antiretroviral medications, increased morbidity and mortality, and greater HIV transmission risks among rural residents. New testing strategies are needed that address challenges to HIV testing and diagnosis specific to rural areas.
authors.affiliation: Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA. kweis2@yahoo.com
authors.forename: Kristina E
authors.initials: KE
authors.lastname: Weis
authors.forename: Angela D
authors.initials: AD
authors.lastname: Liese
authors.forename: James
authors.initials: J
authors.lastname: Hussey
authors.forename: James J
authors.initials: JJ
authors.lastname: Gibson
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Duffus
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D042241:Early Diagnosis; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012720:Severity of Illness Index; D013022:South Carolina / Q000453:epidemiology; D055815:Young Adult