title: A Minority of Patients Newly Diagnosed with AIDS Are Started on Antiretroviral Therapy at the Time of Diagnosis in a Large Public Hospital in the Southeastern United States.
abstract: Prompt antiretroviral therapy (ART) initiation after AIDS diagnosis, in the absence of certain opportunistic infections such as tuberculosis and cryptococcal meningitis, delays disease progression and death, but system barriers to inpatient ART initiation at large hospitals in the era of modern ART have been less studied. We reviewed hospitalizations for persons newly diagnosed with AIDS at Grady Memorial Hospital in Atlanta, Georgia in 2011 and 2012. Individual- and system-level variables were collected. Logistic regression models were used to estimate the odds ratios (ORs) for ART initiation prior to discharge. With Georgia Department of Health surveillance data, we estimated time to first clinic visit, ART initiation, and viral suppression. In the study population (n = 81), ART was initiated prior to discharge in 10 (12%) patients. Shorter hospital stay was significantly associated with lack of ART initiation at the time of HIV diagnosis (8 versus 24 days, OR: 1.14, 95% confidence interval: 1.04-1.25). Reducing barriers to ART initiation for newly diagnosed HIV-positive patients with short hospital stays may improve time to viral suppression.
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.|2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Neela D
authors.initials: ND
authors.lastname: Goswami
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Colasanti
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Khoubian
authors.affiliation: 3 Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Yijian
authors.initials: Y
authors.lastname: Huang
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Armstrong
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.|4 Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Rio
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000821:virology; D006760:Hospitalization / Q000706:statistics & numerical data; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: antiretroviral initiation; hospitalized; inpatient; system barriers