AIDS and Behavior
Volume 22, Issue 8, 2018, Pages 2575-2583

Assessing Timely Presentation to Care Among People Diagnosed with HIV During Hospital Admission: A Population-Based Study in Ontario, Canada (Article) (Open Access)

Kendall C.E.* , Shoemaker E.S. , Raboud J. , Mark A.E. , Bayoumi A.M. , Burchell A.N. , Loutfy M. , Rourke S.B. , Liddy C.E. , Rosenes R. , Rogers T. , Antoniou T.
  • a Department of Family Medicine, University of Ottawa, Ottawa, Canada, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St., Annex E, Ottawa, ON K1N 5C8, Canada, Institute for Clinical Evaluative Sciences, Toronto, Canada, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
  • b Department of Family Medicine, University of Ottawa, Ottawa, Canada, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St., Annex E, Ottawa, ON K1N 5C8, Canada, Institute for Clinical Evaluative Sciences, Toronto, Canada
  • c Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
  • d Institute for Clinical Evaluative Sciences, Toronto, Canada
  • e Institute for Clinical Evaluative Sciences, Toronto, Canada, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada, Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada, Department of Medicine, University of Toronto, Toronto, Canada
  • f Institute for Clinical Evaluative Sciences, Toronto, Canada, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Department of Medicine, University of Toronto, Toronto, Canada
  • g Institute for Clinical Evaluative Sciences, Toronto, Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada, Department of Medicine, University of Toronto, Toronto, Canada, Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
  • h Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada, Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada, Department of Psychiatry, University of Toronto, Toronto, Canada
  • i Department of Family Medicine, University of Ottawa, Ottawa, Canada, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St., Annex E, Ottawa, ON K1N 5C8, Canada
  • j C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St., Annex E, Ottawa, ON K1N 5C8, Canada
  • k CATIE (Canadian AIDS Treatment Information Exchange), Toronto, Canada
  • l Institute for Clinical Evaluative Sciences, Toronto, Canada, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada, Department of Medicine, University of Toronto, Toronto, Canada

Abstract

Timely presentation to care for people newly diagnosed with HIV is critical to optimize health outcomes and reduce onward HIV transmission. Studies describing presentation to care following diagnosis during a hospital admission are lacking. We sought to assess the timeliness of presentation to care and to identify factors associated with delayed presentation. We conducted a population-level study using health administrative databases. Participants were all individuals older than 16 and newly diagnosed with HIV during hospital admission in Ontario, Canada, between April 1, 2007 and March 31, 2015. We used modified Poisson regression models to derive relative risk ratios for the association between sociodemographic and clinical variables and the presentation to out-patient HIV care by 90 days following hospital discharge. Among 372 patients who received a primary HIV diagnosis in hospital, 83.6% presented to care by 90 days. Following multivariable analysis, we did not find associations between patient sociodemographic or clinical characteristics and presentation to care by 90 days. In a secondary analysis of 483 patients diagnosed during hospitalization but for whom HIV was not recorded as the principal reason for admission, 73.1% presented to care by 90 days. Following multivariable adjustment, we found immigrants from countries with generalized HIV epidemics (RR 1.265, 95% CI 1.133–1.413) were more likely to present to care, whereas timely presentation was less likely for people with a mental health diagnosis (RR 0.817, 95% CI 0.742–0.898) and women (RR 0.748, 95% CI 0.559–1.001). Future work should evaluate mechanisms to facilitate presentation to care among these populations. © 2018, The Author(s).

Author Keywords

Care presentation Linkage Institute for Clinical Evaluative Sciences (ICES) Cascade HIV/AIDS

Index Keywords

HIV Infections hospitalization Human immunodeficiency virus infection human middle aged Odds Ratio statistics and numerical data time factor Time Factors Young Adult Humans migrant male Emigrants and Immigrants female Multivariate Analysis Ontario adult ambulatory care aftercare
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85043681771&doi=10.1007%2fs10461-018-2063-z&partnerID=40&md5=79dc34e62f35883466ecb419e4b65ddd
DOI: 10.1007/s10461-018-2063-z
ISSN: 10907165
Original Language: English