title: Factors Associated with Delayed Enrollment in HIV Medical Care among HIV-Positive Individuals in Odessa Region, Ukraine.
abstract: In Ukraine, about one-third of identified HIV-positive individuals are not connected to care. We conducted a cross-sectional survey (n = 200) among patients registered at Odessa AIDS centers in October to December 2011. Factors associated with delayed enrollment in HIV care (>3 months since positive HIV test) were evaluated using logistic regression. Among study participants (mean age 35 ± 8.2 years, 47.5% female, 42.5% reported history of injecting drugs), 55% delayed HIV care enrollment. Odds of delayed enrollment were higher for those with lower educational attainment (adjusted odds ratio [aOR]: 2.65, 95% confidence interval [CI]: 1.04-6.76), not feeling ill (aOR: 2.98, 95% CI: 1.50-5.93), or not having time to go to the AIDS center (aOR: 3.89, 95% CI: 1.39-10.89); injection drug use was not associated with delayed enrollment. Programs linking HIV-positive individuals to specialized care should address enrollment barriers and include education on HIV care benefits and case management for direct linkage to care. HIV testing and treatment should be coupled to ensure a continuum of care.
authors.affiliation: 1 Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
authors.forename: Oleksandr
authors.initials: O
authors.lastname: Neduzhko
authors.affiliation: 2 Ukrainian I. I. Mechnikov Research Anti-Plague Institute, Odessa, Ukraine.
authors.forename: Oleksandr
authors.initials: O
authors.lastname: Postnov
authors.affiliation: 3 WHO Country Office in Ukraine, Kyiv, Ukraine.
authors.forename: Ihor
authors.initials: I
authors.lastname: Perehinets
authors.affiliation: 4 Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: DeHovitz
authors.affiliation: 5 Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Joseph
authors.affiliation: 4 Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Odegaard
authors.affiliation: 6 Department of English, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Kaplan
authors.affiliation: 1 Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
authors.forename: Tetiana
authors.initials: T
authors.lastname: Kiriazova
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012307:Risk Factors; D015819:Substance Abuse, Intravenous; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014455:Ukraine / Q000453:epidemiology
keywords: HIV care; Ukraine; barriers to care; delayed HIV care entry; linkage to care