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People with Medicaid coverage and a usual source of care are less likely than others to delay care after HIV diagnosis

Delayed medical care after an initial diagnosis of HIV infection prevents patients from receiving medical therapies that may preserve their immune system and reduce the risk of serious disease-related complications. Unfortunately, delays of several months or longer between HIV diagnosis and first medical care are not uncommon, concludes a study supported by the Agency for Healthcare Research and Quality (HS08578).

In a study led by Barbara J. Turner, M.D., of the University of Pennsylvania, researchers examined responses from interviews of a nationally representative sample of people with HIV infection receiving care in the United States (the HIV Cost and Services Utilization Study [HCSUS]) to determine time from diagnosis to first care. They found that 1,540 patients in group A, diagnosed by February 1993, were in care within 3 years; the 1,960 patients in group B, diagnosed by February 1995, were in care within 1 year of diagnosis. A delay of more than 3 months occurred for 29 percent of group A and 17 percent of group B. Having a usual source of care at diagnosis reduced delay in group A by 40 percent (adjusted odds ratio, OR 0.61) and by 30 percent in group B (OR 0.70). Patients covered by Medicaid at diagnosis were half as likely to delay treatment as privately insured patients (group A, OR 0.52 and group B, OR 0.48). People who were not sick and those who tested positive for HIV in 1991 or earlier were more likely to have delayed care. Also, people 25 years of age or younger, Hispanics and blacks, and those with HIV exposure from intravenous drug use, were more likely to report more than 3 months' delay in receiving care. Delay was also more likely for people who were tested in an anonymous testing center or a non-health care setting such as a prison or blood donation center.

More details are in "Delayed medical care after diagnosis in a U.S. national probability sample of persons infected with human immunodeficiency virus," by Dr. Turner, William E. Cunningham, M.D., M.P.H., Naihua Duan, Ph.D., and others, in the September 25, 2000 Archives of Internal Medicine 160, pp. 2614-2622.

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