title: Achieving Core Indicators for HIV Clinical Care Among New Patients at an Urban HIV Clinic.
abstract: Following the release of the 2010 National HIV/AIDS Strategy for the United States, the Institute of Medicine (IOM) issued core clinical indicators for measuring health outcomes in HIV-positive persons. As early retention in HIV primary care is associated with improved long-term health outcomes, we employed IOM indicators as a guide to examine a cohort of persons initiating HIV outpatient medical care at a university-affiliated HIV clinic in the Southern United States (January 2007-July 2012). Using indicators for visit attendance, CD4 and viral load laboratory testing frequency, and antiretroviral therapy initiation, we evaluated factors associated with achieving IOM core indicators among care- and treatment-naïve patients during the first year of HIV care. Of 448 patients (mean age = 35 years, 35.7% white, 79.0% male, 58.4% education beyond high school, 35.9% monthly income > $1,000 US, 47.3% uninsured), 84.6% achieved at least four of five IOM indicators. In multivariable analyses, persons with monthly income > $1,000 (ORadj. = 3.71; 95% CI: 1.68-8.19; p = 0.001) and depressive symptoms (ORadj. = 2.13; 95% CI: 1.02-4.45; p = 0.04) were significantly more likely to achieve at least four of the five core indicators, while patients with anxiety symptoms were significantly less likely to achieve these indicators (ORadj. = 0.50; 95% CI: 0.26-0.97; p = 0.04). Age, sex, race, education, insurance status, transportation barriers, alcohol use, and HIV status disclosure to family were not associated with achieving core indicators. Evaluating and addressing financial barriers and anxiety symptoms during the first year of HIV outpatient care may improve individual health outcomes and subsequent achievement of the National HIV/AIDS Strategy.
authors: 1 University of Alabama School of Medicine , Birmingham, Alabama.|2 John Peter Smith Hospital , Fort Worth, Texas.
authors: Gillian A
authors: GA
authors: Greer
authors: 3 Department of Medicine-Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors: Ashutosh
authors: A
authors: Tamhane
authors: 3 Department of Medicine-Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors: Rakhi
authors: R
authors: Malhotra
authors: 3 Department of Medicine-Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors: Greer A
authors: GA
authors: Burkholder
authors: 3 Department of Medicine-Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors: Michael J
authors: MJ
authors: Mugavero
authors: 3 Department of Medicine-Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors: James L
authors: JL
authors: Raper
authors: 3 Department of Medicine-Division of Infectious Diseases, University of Alabama at Birmingham , Birmingham, Alabama.
authors: Anne
authors: A
authors: Zinski
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D023241:Antiretroviral Therapy, Highly Active; D001007:Anxiety / Q000150:complications; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003863:Depression / Q000150:complications; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D006305:Health Status Indicators; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance / Q000379:methods*; D036301:Qualitative Research; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014505:Urban Population; D019562:Viral Load