title: The increasing impact of human immunodeficiency virus infections, sexually transmitted diseases, and viral hepatitis in Durham County, North Carolina: a call for coordinated and integrated services.
abstract: BACKGROUND
  Durham County, North Carolina, faces high rates of human immunodeficiency virus (HIV) infection (with or without progression to AIDS) and sexually transmitted diseases (STDs). We explored the use of health care services and the prevalence of coinfections, among HIV-infected residents, and we recorded community perspectives on HIV-related issues.
  
  
  METHODS
  We evaluated data on diagnostic codes, outpatient visits, and hospitalizations for individuals with HIV infection, STDs, and/or hepatitis B or C who visited Duke University Hospital System (DUHS). Viral loads for HIV-infected patients receiving care were estimated for 2009. We conducted geospatial mapping to determine disease trends and used focus groups and key informant interviews to identify barriers and solutions to improving testing and care.
  
  
  RESULTS
  We identified substantial increases in HIV/STDs in the southern regions of the county. During the 5-year period, 1,291 adults with HIV infection, 4,245 with STDs, and 2,182 with hepatitis B or C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were coinfected with an STD or hepatitis B or C, respectively. In 2009, 65.7% of HIV-infected persons receiving care had undetectable viral loads. Barriers to testing included stigma, fear, and denial of risk, while treatment barriers included costs, transportation, and low medical literacy.
  
  
  CONCLUSIONS
  Data for health care utilization and HIV load were available from different periods. Focus groups were conducted among a convenience sample, but they represented a diverse population.
  
  
  CONCLUSIONS
  Durham County has experienced an increase in the number of HIV-infected persons in the county, and coinfections with STDs and hepatitis B or C are common. Multiple barriers to testing/treatment exist in the community. Coordinated care models are needed to improve access to HIV care and to reduce testing and treatment barriers.
authors.affiliation: Piedmont HIV Health Consortium, Durham, North Carolina, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Kolman
authors.forename: Mary
authors.initials: M
authors.lastname: DeCoster
authors.forename: Rae Jean
authors.initials: RJ
authors.lastname: Proeschold-Bell
authors.forename: Genevieve Ankeny
authors.initials: GA
authors.lastname: Hunter
authors.forename: John
authors.initials: J
authors.lastname: Bartlett
authors.forename: Arlene C
authors.initials: AC
authors.lastname: Seña
mesh_terms: D000293:Adolescent; D000328:Adult; D060085:Coinfection / Q000453:epidemiology; D005260:Female; D017144:Focus Groups; D040362:Geographic Information Systems; D015658:HIV Infections / Q000453:epidemiology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006509:Hepatitis B / Q000453:epidemiology* / Q000821:virology; D006526:Hepatitis C / Q000453:epidemiology* / Q000821:virology; D006525:Hepatitis, Viral, Human / Q000453:epidemiology; D006801:Humans; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000821:virology; D019562:Viral Load; D055815:Young Adult