Insurance, Housing, Age Tied to Unstable Early HIV Care in SF

Lack of insurance or housing and younger age predicted poor engagement in care and low viral suppression rates among people newly diagnosed with HIV in San Francisco.

After a person gets diagnosed with HIV infection, referral to care, retention in care, and HIV suppression remain challenges in populations across the world. To determine rates and predictors of these outcomes, researchers in San Francisco studied residents of the city diagnosed with HIV in 2009 and 2010.

Among 862 people diagnosed with HIV, 750 (87%) entered care within 6 months of their diagnosis. Of those 750 people, 540 (72%) had a second visit in the following 3 to 6 months, and 432 of those 540 (80%) had a third visit in the next 3 to 6 months.

Only half of the total population reached an undetectable viral load within 12 months of diagnosis, compared with 76% of those who made at least 3 visits after their diagnosis.

Lack of health insurance and unknown housing status were linked to not entering care after HIV diagnosis (P < 0.01). People with an unknown insurance status were less likely to make two office visits after their diagnosis, and people younger than 30 were less likely to return for a third visit.

Multivariate analysis identified four independent predictors of failure to reach an undetectable viral load within 12 months of diagnosis: age under 40, homelessness, unknown housing status, and having one or two office visits compared with three visits.

The researchers note that neither race nor gender affected engagement in care in this population.

Source: Dharushana Muthulingam, Jennie Chin, Ling Hsu, Susan Scheer, Sandra Schwarcz. Disparities in engagement in care and viral suppression among persons with HIV. JAIDS. 2013; 63: 112-119.

Written by Mark Mascolini on behalf of the International AIDS Society