Temporal Trends in Presentation for Outpatient HIV Medical Care 2000-2010: Implications for Short-term Mortality
Authors
Seal, Paula S.Jackson, David A.
Chamot, Eric
Willig, James H.
Nevin, Christa R.
Allison, Jeroan J.
Raper, James L.
Kempf, Mirjam
Schumacher, Joseph E.
Saag, Michael S.
Mugavero, Michael J.
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2011-07-06Keywords
HIV InfectionsTime Factors
Outpatients
UMCCTS funding
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
BACKGROUND: Many newly diagnosed patients present to outpatient care with advanced HIV infection. More timely HIV diagnosis and initiation of care has the potential to improve individual health outcomes and has public health implications. OBJECTIVE: To assess temporal trends in late presentation for outpatient HIV medial care as measured by CD4 count/mm(3) and the implications on short-term (1-year) mortality. DESIGN: We conducted a cohort study nested in a prospective HIV clinical cohort including patients establishing initial outpatient HIV treatment between 2000-2010. Time series regression analysis evaluated temporal trends in late presentation for care measured by the proportion of patients with a CD4 count/mm(3) or an opportunistic infection at enrollment, and also evaluated trends in short-term mortality. PARTICIPANTS: Patients establishing initial outpatient HIV treatment between 2000-2010 at an academic HIV clinic. MAIN MEASURES: The proportion of patients with a CD4 count/mm(3) or an opportunistic infection at initial presentation and short-term (1-year) mortality following clinic enrollment. KEY RESULTS: Among 1121 patients, 41% had an initial CD4 count/mm(3), 25% had an opportunistic infection and 2.4% died within 1-year of their initial visit. Time series regression analysis demonstrated significant reductions in late presentation for HIV care and decreases in short-term mortality with temporal improvement preceding updated CDC HIV testing recommendations. CONCLUSION: We observed a significant decline in the number of patients presenting for outpatient HIV care with advanced disease, particularly in 2006-2010. A significant trend in improved short-term survival among patients establishing HIV care was also observed, likely related to more timely presentation for outpatient care in more recent years.Source
J Gen Intern Med. 2011 Jul;26(7):745-50. Epub 2011 Apr 5. Link to article on publisher's siteDOI
10.1007/s11606-011-1693-xPermanent Link to this Item
http://hdl.handle.net/20.500.14038/47869PubMed ID
21465301Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1007/s11606-011-1693-x