AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #186 - Factors associated with delayed diagnosis of HIV disease among adults and adolescents in rural populations -- 40 states, 2006 - 2008
Authors: Presenting Author: Ms Cheryl Williams - Centers for Disease Control
Additional Authors: Ms. Denise Hughes,
Aim: Diagnosis of HIV infection late in the course of disease leads to higher HIV-related morbidity and mortality, poorer treatment outcomes, and increased HIV transmission. Overall, compared with urban areas, HIV-infected persons in rural areas are more likely to be non-white and have lower socioeconomic status, limited access to care, greater stigma surrounding HIV and concerns over confidentiality, and lower perceptions of risk. These factors may lead to reduced testing and delayed HIV diagnosis among rural residents. We sought to identify demographic and behavioral factors associated with delayed diagnosis among persons in rural populations, and whether these factors differed between rural and urban populations.
Method / Issue: Using data from 40 states with mature HIV reporting systems, we evaluated characteristics of adults/adolescents (age >=13 years) diagnosed with HIV in 2006 - 2008 in rural populations (nonmetropolitan areas <50,000 population), comparing those with delayed HIV diagnosis (defined as AIDS diagnosis within one year of HIV diagnosis) to those with non-delayed diagnosis. We also compared characteristics among those with delayed diagnosis in rural vs. urban populations (metropolitan statistical areas >=500,000 population). We examined the association between delayed diagnosis and gender, race/ethnicity, age at HIV diagnosis, and transmission category using chi-square (X2) tests. Data were adjusted for reporting delay and missing risk factors.
Results / Comments: Of the 9,659 persons diagnosed with HIV among rural populations during 2006 - 2008, 73% were male, and 51% were black/African American, 36% were white and 10% were Hispanic/Latino. The primary transmission category for males was male-to-male sexual contact (MSM; 62%) and for females, heterosexual contact (HET; 83%). Overall, 36% (3,522/9,659) had delayed diagnosis. Significant differences (p <0.05) in the proportion of delayed diagnosis were evident across sex (males, 39%; females, 30%), race/ethnicity (Hispanics/Latinos, 44%; whites, 39%; blacks/African Americans, 33%), and age groups (increasing from 17% in those age 13-24 years, to 50% in those age >=50 years). By transmission category, the highest proportion of delayed diagnosis among males was in those classified as HET (43%), and among females, injection drug use (IDU; 37%). Among 99,132 HIV diagnoses in urban populations, distribution by demographic and transmission categories factors was similar to that in rural populations, except for a higher proportion of Hispanics/Latinos (19%). Overall, 33% (33,154/99,132) had delayed diagnosis. By transmission category, the highest proportion of delayed diagnosis among urban populations was in those with IDU classification (males: 44%; females: 38%).
Discussion: In rural populations in the 40 states, the proportion of delayed diagnosis differed across demographic and behavior groups. In contrast to urban populations, this proportion was highest among rural males in the HET transmission category. To reduce new HIV infections and associated morbidity and mortality, it is necessary to increase awareness of risk and develop effective testing programs for groups with higher proportions of delayed diagnosis. Early access to treatment and prevention services for those testing positive should also be provided.
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