Persons with unrecognized HIV infection forgo timely clinical intervention and may unknowingly transmit HIV to partners. In North Carolina (NC), unrecognized infection and late diagnosis are common. To understand more about the individual and structural factors associated with HIV diagnosis and presentation to care, this dissertation examined three sources of data from HIV-positive patients in NC. We analyzed data from 75 patients with acute HIV infection identified through the Screening and Tracing Active Transmission (STAT) program to understand more about motivations for testing during early infection. We found that nearly one-third of patients had a sexually transmitted co-infection at the time of HIV diagnosis. The prevalence of co-infection was highest in women compared to heterosexual men (PR=0.67, 95% CI 0.31, 1.45) and men who have sex with men (PR=0.34, 95% CI 0.15, 0.76). To understand the effect of perceived social support on late presentation to medical care, we examined data from the University of North Carolina Infectious Disease Clinic Clinical and Socio-Demographic Survey. We analyzed data from 216 HIV positive patients and quantified the four functional domains of social support with a modified Medical Outcomes Study Social Support Scale. We found the median delay between diagnosis and entry to primary care was 5.9 months. Only positive social interaction support was associated with delayed presentation in adjusted models. The effect of low perceived positive social interaction on delayed presentation differed by history of a drinking problem (history of alcoholism HR=0.71, 95% confidence interval (CI): 0.40, 1.28; no alcoholism HR=1.43, 95% CI: 0.88, 2.34). Finally, we conducted a qualitative interview study of 24 HIV positive patients entering care at the UNC ID clinic with moderate to advanced immunosuppression to describe attitudes and beliefs about HIV testing and care. The primary barrier to HIV testing prior to diagnosis was perception of risk; consequently, most participants were diagnosed after the onset of clinical symptoms. While patients were anxious to initiate care rapidly after diagnosis, some felt frustrated by the passive process of connecting to specialty care. The first visit with an HIV care provider was identified as critical in the coping process.
CHAPTER THREE: DESCRIPTION OF DATA SOURCES The Screening and
Tracing Active Transmission Program Since the advent of the Screening and
Tracing Active Transmission (STAT) program in North Carolina in November of
2002, ...
