Background. HIV/AIDS ranks high among health problems affecting the United States. Studies indicate current national estimates for People living with HIV/AIDS (PLWH/As) not in care (NIC) ranges between 42%-59%.
Purpose. The purpose of this study is to (a) examine characteristics of PLWH/As not-in-care, (b) identify their health utilization behaviors, (c) their common diagnoses and (d) examine change in care patterns from 2004-2006.
Methods. This study utilized secondary datasets. A data file of all PLWH/As living in South Carolina (SC) reported to the HIV/AIDS Reporting System (HARS) and alive at December 31st, 2003 was linked to the statewide all payer health-care database to track health utilization for 2004-2005. Reporting of HIV laboratory markers is mandatory by law in South Carolina and HIV medical-care was defined as receipt of a viral load or CD4 cell count each calendar year. Logistic regression was used to estimate relationships between care status, demographic and transmission factors and health utilization. Multinomial logistic regression was used to assess change in care patterns.
Results. Of the 13,042 useable population sample, majority were Black 9,319 (71.61%), male 3,869 (29.67%) and urban residents 7,933 (62.41%). About 5,219 (40.02%) were persistently NIC, 3,304 (25.33%) transitioned in and out of care (TC) while 4,519 (34.65%) were IC from 2004-2006. Blacks were less likely to be persistently NIC (OR, 0.88; C.I, 0.78, 0.99) compared to Whites. Between 2004 and 2005, 5,130 (39%) persons made one or more visits to a hospital facility amounting to 35,959 visits (median 4; range 1–88). Persons with at least one inpatient discharge during the 2004-2005 period had decreased odds of being persistently NIC (OR, 0.97; C.I, 0.24, 0.33.). An inpatient HIV diagnoses decreased the odds of persons being persistently NIC (OR, 024; C.I, 0.18, 0.31.)
Conclusions. Decreasing mortality and controlling the HIV epidemic will not be successful in SC unless NICs are brought into HIV medical care. Missed opportunities in hospital settings visited require targeted interventions to re-engage NIC persons back into care. Future research is needed to discover why people stay out of care and particularly why SC Whites are more likely to be NIC.