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HIV Care Initiation Delay Among Rural Residents in the Southeastern United States, 1996 to 2012.

ABSTRACT: BACKGROUND:Delaying HIV care initiation may lead to greater morbidity, mortality, and further HIV transmission. Rural residence may be associated with delayed diagnosis and linkage to care, with negative clinical outcomes. OBJECTIVE:To examine the association between rural patient residence and CD4 cell count at HIV care initiation in a large HIV clinical cohort in the Southeastern United States. METHODS:We included HIV-infected patients who initiated care between 1996 and 2012 with a geocodable address and no previous history of HIV clinical care. Patient residence was categorized as urban or rural using United States Department of Agriculture Rural Urban Commuting Area codes. Multivariable linear regression models were fit to estimate the association between patient residence and CD4 cell count at HIV care initiation. RESULTS:Among 1396 patients who met study inclusion criteria, 988 had a geocodable address. Overall, 35% of patients resided in rural areas and presented to HIV care with a mean CD4 cell count of 351 cells/mm (SD, 290). Care initiation mean CD4 cell counts increased from 329 cells/mm (SD, 283) in 1996-2003 to 391 cells/mm (SD, 292) in 2008-2012 (P = 0.006). Rural in comparison with urban patients presented with lower CD4 cell counts with an unadjusted and adjusted mean difference of -48 cells/mm [95% confidence interval, -86 to -10) and -37 cells/mm (95% confidence interval: -73 to -2), respectively, consistently observed across calendar years. CONCLUSIONS:HIV care initiation at low CD4 cell counts was common in this Southeastern US cohort and more common among rural area residents.

SUBMITTER: Lopes BLW

PROVIDER: S-EPMC5850947 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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HIV Care Initiation Delay Among Rural Residents in the Southeastern United States, 1996 to 2012.

Lopes Brettania L W BLW Eron Joseph J JJ Mugavero Michael J MJ Miller William C WC Napravnik Sonia S

Journal of acquired immune deficiency syndromes (1999) 20171001 2

<h4>Background</h4>Delaying HIV care initiation may lead to greater morbidity, mortality, and further HIV transmission. Rural residence may be associated with delayed diagnosis and linkage to care, with negative clinical outcomes.<h4>Objective</h4>To examine the association between rural patient residence and CD4 cell count at HIV care initiation in a large HIV clinical cohort in the Southeastern United States.<h4>Methods</h4>We included HIV-infected patients who initiated care between 1996 and ...[more]

PMID: 28639994

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Project description:ImportanceLittle is known about recent trends in rural-urban disparities in youth suicide, particularly sex- and method-specific changes. Documenting the extent of these disparities is critical for the development of policies and programs aimed at eliminating geographic disparities.ObjectiveTo examine trends in US suicide mortality for adolescents and young adults across the rural-urban continuum.Design, setting, and participantsLongitudinal trends in suicide rates by rural and urban areas between January 1, 1996, and December 31, 2010, were analyzed using county-level national mortality data linked to a rural-urban continuum measure that classified all 3141 counties in the United States into distinct groups based on population size and adjacency to metropolitan areas. The population included all suicide decedents aged 10 to 24 years.Main outcomes and measuresRates of suicide per 100,000 persons.ResultsAcross the study period, 66,595 youths died by suicide, and rural suicide rates were nearly double those of urban areas for both males (19.93 and 10.31 per 100,000, respectively) and females (4.40 and 2.39 per 100,000, respectively). Even after controlling for a wide array of county-level variables, rural-urban suicide differentials increased over time for males, suggesting widening rural-urban disparities (1996-1998: adjusted incidence rate ratio [IRR], 0.98; 2008-2010: adjusted IRR, 1.19; difference in IRR, P = .02). Firearm suicide rates declined, and the rates of hanging/suffocation for both males and females increased. However, the rates of suicide by firearm (males: 1996-1998, 2.05; and 2008-2010: 2.69 times higher) and hanging/suffocation (males: 1996-1998, 1.24; and 2008-2010: 1.63 times higher) were disproportionately higher in rural areas, and rural-urban differences increased over time (P = .002 for males; P = .06 for females).Conclusions and relevanceSuicide rates for adolescents and young adults are higher in rural than in urban communities regardless of the method used, and rural-urban disparities appear to be increasing over time. Further research should carefully explore the mechanisms whereby rural residence might increase suicide risk in youth and consider suicide-prevention efforts specific to rural settings.

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HIV Care Initiation Delay Among Rural Residents in the Southeastern United States, 1996 to 2012.

Publications

HIV Care Initiation Delay Among Rural Residents in the Southeastern United States, 1996 to 2012.

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