title: Assessing receipt of medical care and disparity among persons with HIV/AIDS in San Francisco, 2006-2007.
abstract: We used data from HIV/AIDS surveillance case registry to assess the timing of entry into medical care, level of care received after HIV diagnosis, and to identify characteristics associated with delayed and insufficient care among persons diagnosed with HIV/AIDS between 2006 and 2007 in San Francisco. Laboratory reports of HIV viral load and CD4 test results were used as a marker for receipt of medical care. The time from HIV diagnosis to entry into care was estimated using Kaplan-Meier product limit method and independent predictors of delayed entry into care were determined using the proportional hazards model. Insufficient care was defined as less than an average of two viral load/CD4 tests per person-year of follow-up. Predictors of insufficient care were evaluated using a logistic regression model. An estimated 85% of persons diagnosed with HIV/AIDS entered care within three months after HIV diagnosis; the proportion increased to 95% within 12 months after diagnosis. Persons who were born outside of the USA and those tested at the public counseling and testing sites were more likely to delay care. Nineteen percent of persons were determined to have received insufficient care. Younger persons and those diagnosed at a hospital were more likely to receive insufficient care. A high proportion of persons diagnosed with HIV/AIDS in San Francisco established timely and adequate care after HIV diagnosis. However, delays for some individuals in entry into care and markers of insufficient care suggest that there remains a need to improve access to and sustainability of HIV-specific medical care.
authors.affiliation: San Francisco Department of Public Health, USA. ling.hsu@sfdph.org
authors.forename: Ling C
authors.initials: LC
authors.lastname: Hsu
authors.forename: Mi
authors.initials: M
authors.lastname: Chen
authors.forename: Jessica
authors.initials: J
authors.lastname: Kali
authors.forename: Sharon
authors.initials: S
authors.lastname: Pipkin
authors.forename: Susan
authors.initials: S
authors.lastname: Scheer
authors.forename: Sandy
authors.initials: S
authors.lastname: Schwarcz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000458:organization & administration / Q000592:standards; D003153:Community Health Services / Q000458:organization & administration* / Q000592:standards; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy*; D006679:HIV Seropositivity / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012495:San Francisco; D013997:Time Factors; D019562:Viral Load; D055815:Young Adult