title: Engagement in HIV care among HIV-positive men who have sex with men from 21 cities in the United States.
abstract: We assessed factors associated with HIV care among HIV-infected men who have sex with men (MSM). We used 2008 data on MSM from the National HIV Behavioral Surveillance System (NHBS). Venue-based, time-space sampling was used to recruit and interview men in 21 U.S. cities with high AIDS prevalence. Among self-reported HIV-positive MSM, we used generalized estimating equations (clustered on city of interview) to evaluate factors associated with delayed linkage to care (care entry >3 months after diagnosis), not currently receiving care (no visit for HIV care during the 6 months before the study interview), and not being on antiretroviral therapy (ART). Among 8,153 MSM, 882 (11 %) were self-reported HIV-positive. 25 % had delayed linkage, 12 % were not currently receiving care and among those with at least one heath care visit 30 % were not on ART. In multivariate analysis, lower income and testing positive at their first HIV test were associated with delayed linkage. Age 18-29 years, and not having health insurance were associated with not currently receiving care. Among those with at least one health care visit, being age 18-39 years, having private or no health insurance, and stimulant use were associated with not being on ART. These findings can inform efforts to improve engagement in care.
authors.affiliation: Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA, gmb5@cdc.gov.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Paz-Bailey
authors.forename: Huong
authors.initials: H
authors.lastname: Pham
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Oster
authors.forename: Amy
authors.initials: A
authors.lastname: Lansky
authors.forename: Trista
authors.initials: T
authors.lastname: Bingham
authors.forename: Ryan E
authors.initials: RE
authors.lastname: Wiegand
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dinenno
authors.forename: Jacek
authors.initials: J
authors.lastname: Skarbinski
authors.forename: James D
authors.initials: JD
authors.lastname: Heffelfinger
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D018451:Homosexuality, Male; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011159:Population Surveillance; D015995:Prevalence; D012309:Risk-Taking; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents