Behavioral and clinical characteristics of people receiving medical care for HIV infection in an outpatient facility in Sicily, Italy.
OBJECTIVE
The authors examined a cohort of HIV-positive outpatients at the AIDS Center of Palermo University in Italy in order to identify factors related to the frequency of their visits to the outpatient facility for health care services.


METHODS
Two hundred and twenty-four HIV-infected subjects were enrolled in the study. Demographic and HIV disease characteristics were recorded and assessed with the number of days accessed to our outpatients unit in univariate and multivariate analyses. The potential relationship with immunological status was also analyzed stratifying the patients into groups according to their CD4(+) T-cell counts (≥500 vs <500/mm(3), and ≥200 vs <200/mm(3)).


RESULTS
Both univariate and multivariate analyses showed that duration of antiretroviral therapy <5 years and hypertension were significantly associated with a CD4(+) T-cell count of <500/mm(3), whereas geographic origin (Africa) was associated with a CD4(+) T-cell count of <200/mm(3). Mean number of days the patients sought access to day-care services for laboratory tests was negatively associated with CD4(+) T-cell count.


CONCLUSIONS
Patients with low CD4(+) T-cell counts showed higher use of health care services, demonstrating how early HIV diagnosis can help to reduce health care costs. The CD4(+) T-cell cut-off of 200 cells emphasizes the importance of identifying and managing HIV infection among hard-to-reach groups like vulnerable migrants. In our sample, the illegal status of immigrants does not influence the management of their HIV/AIDS condition, but the lack of European health card that documents the current antiretroviral status, could interfere with the efforts to eradicate AIDS. A better understanding of the major determinants of HIV treatment costs has led to appropriate large-scale actions, which in turn has increased resources and expanded intervention programs. Further guidance should be offered to hard-to-reach groups in order to improve early AIDS diagnosis, and procedures for identifying and managing these vulnerable subjects should be made available to care commissioners and service providers.
Department of Sciences for Health Promotion and Mother-Child Care "G D'Alessandro", University of Palermo, Palermo, Italy.
Paola
P
Di Carlo
Department of Sciences for Health Promotion and Mother-Child Care "G D'Alessandro", University of Palermo, Palermo, Italy.
Giuliana
G
Guadagnino
Department of Sciences for Health Promotion and Mother-Child Care "G D'Alessandro", University of Palermo, Palermo, Italy.
Palmira
P
Immordino
Department of Medicinal Clinics and Emerging Diseases, "Paolo Giaccone" Polyclinic University Hospital, Palermo, Italy.
Giovanni
G
Mazzola
Department of Medicinal Clinics and Emerging Diseases, "Paolo Giaccone" Polyclinic University Hospital, Palermo, Italy.
Pietro
P
Colletti
Department of Sciences for Health Promotion and Mother-Child Care "G D'Alessandro", University of Palermo, Palermo, Italy.
Ilenia
I
Alongi
Department of Sciences for Health Promotion and Mother-Child Care "G D'Alessandro", University of Palermo, Palermo, Italy.
Lucia
L
Adamoli
Department of Sciences for Health Promotion and Mother-Child Care "G D'Alessandro", University of Palermo, Palermo, Italy.
Francesco
F
Vitale
Department of Sciences for Health Promotion and Mother-Child Care "G D'Alessandro", University of Palermo, Palermo, Italy.
Alessandra
A
Casuccio
CD4+ T-cell count; HIV infection; HIV outpatient service; access to care; hard-to-reach groups; resource use