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Associations of Rural Residence With Timing of HIV Diagnosis and Stage of Disease at Diagnosis, South Carolina 2001-2005

Authors

  • Kristina E. Weis PhD, MPH,

    1. Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
    2. Bureau of Environmental Public Health Medicine, Division of Environmental Health, Florida Department of Health, Tallahassee, Florida
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  • Angela D. Liese PhD, MPH,

    1. Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
    2. Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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  • James Hussey PhD,

    1. Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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  • James J. Gibson MD, MPH,

    1. Bureau of Disease Control, South Carolina Department of Health and Environmental Control, Columbia, South Carolina
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  • Wayne A. Duffus MD, PhD

    1. Bureau of Disease Control, South Carolina Department of Health and Environmental Control, Columbia, South Carolina
    2. Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, South Carolina
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  • The authors gratefully acknowledge the assistance of the South Carolina Department of Health and Environmental Control HIV/AIDS surveillance staff in collecting and compiling this surveillance data for use in investigating the HIV epidemic in South Carolina. This manuscript was supported by the Cooperative Agreement #1R36PS000844-01 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. Results were presented previously in poster format at the 2008 National STD Prevention Conference but were not published. For further information, contact: Kristina E. Weis, PhD, Bureau of Environmental Public Health Medicine, Division of Environmental Health, Florida Department of Health, 4052 Bald Cypress Way, Bin A08, Tallahassee, FL 32399-1712; e-mail kweis2@yahoo.com.

Abstract

Context: Rural areas in the southern United States face many challenges, including limited access to health care services and stigma, which may lead to later HIV diagnosis among rural residents.

Purpose: To investigate the associations of rural residence with timing of HIV diagnosis and stage of disease at diagnosis.

Methods: Timing of HIV diagnosis was categorized as a diagnosis of acquired immune deficiency syndrome within 1 year of a first positive HIV test or HIV-only. Stage of disease was based on initial CD4+ T-cell count taken within 1 year of diagnosis. County of residence at HIV diagnosis was classified as urban if the population of the largest city was at least 25,000; it was classified as rural otherwise. Logistic regression was used to analyze timing of HIV diagnosis, and analysis of covariance was used to analyze stage of disease.

Findings: From 2001 to 2005, 4,137 individuals were diagnosed with HIV infection. Of these, 1,129 (27%) were rural and 3,008 (73%) were urban residents. Among rural residents, 533 (47%) were diagnosed late, compared with 1,258 (42%) urban residents. Rural residents were significantly more likely to be diagnosed late (OR 1.19 [95% CI, 1.02-1.38]). Rural residence was associated with lower initial CD4+ T-cell count in crude analysis (P= .01) but not after adjustment (P > .05).

Conclusions: Rural residence is a risk factor for late HIV diagnosis. This may lead to reduced treatment response to antiretroviral medications, increased morbidity and mortality, and greater HIV transmission risks among rural residents. New testing strategies are needed that address challenges to HIV testing and diagnosis specific to rural areas.

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