title: Late HIV diagnosis: Differences by rural/urban residence, Florida, 2007-2011.
abstract: The purpose of this retrospective cohort study was to identify individual-level demographic and community-level socioeconomic and health care resource factors associated with late diagnosis of HIV in rural and urban areas of Florida. Multilevel modeling was conducted with linked 2007-2011 Florida HIV surveillance, American Community Survey, Area Health Resource File, and state counseling and testing data. Late diagnosis (defined as AIDS diagnosis within 3 months of HIV diagnosis) was more common in rural than urban areas (35.8% vs. 27.4%) (p<0.0001). This difference persisted after controlling for age, sex, race/ethnicity, HIV transmission mode, country of birth, and diagnosis year (adjusted OR 1.39; 95% CI 1.17-1.66). In rural areas, older age and male sex were associated with late HIV diagnosis; zip code-level socioeconomic and county level health care resource variables were not associated with late diagnosis in rural areas. In urban areas only, Hispanic and non-Hispanic black race/ethnicity, foreign birth, and heterosexual mode of transmission were additionally associated with late HIV diagnosis. These findings suggest that, in rural areas, enhanced efforts are needed to target older individuals and men in screening programs and that studies of psychosocial and structural barriers to HIV testing in rural and urban areas be pursued.
authors.affiliation: 1 Department of Epidemiology, Florida International University , Miami, Florida.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Trepka
authors.forename: Kristopher P
authors.initials: KP
authors.lastname: Fennie
authors.forename: Diana M
authors.initials: DM
authors.lastname: Sheehan
authors.forename: Khaleeq
authors.initials: K
authors.lastname: Lutfi
authors.forename: Lorene
authors.initials: L
authors.lastname: Maddox
authors.forename: Spencer
authors.initials: S
authors.lastname: Lieb
mesh_terms: D000293:Adolescent; D000328:Adult; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005431:Florida / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult