Abstract
Delayed diagnosis of HIV infection is a common problem. We hypothesized that persons with less trust in physicians and in the healthcare system would be diagnosed with lower CD4 cell counts than persons with more trust because they would delay seeking healthcare. From January 2006 to October 2007, 171 newly diagnosed HIV-infected persons, not yet in HIV primary care, were recruited from HIV testing sites in Houston, Texas, that primarily serve the under- and un-insured. The participants completed instruments measuring trust in physicians and trust in the healthcare system. Initial CD4 cell counts were obtained from medical record review. Mean trust scores for participants with CD4 cell counts ≥200 cells/mm3 were compared with scores from participants with CD4 cell counts <200 cells/mm3. We found that 51% of the cohort was diagnosed with a CD4 cell count <200 cells/mm3. Neither trust in physicians nor trust in the healthcare system was an independent predictor of delayed diagnosis of HIV infection. In multivariate analysis, men who have sex with men and injection drug users were more likely to have early HIV diagnosis. Race/ethnicity was the only variable statistically significantly predictive of trust in physicians and in the healthcare system. Hispanics had the highest trust scores, followed by Blacks and Whites. Low trust is likely not a barrier to timely diagnosis of HIV infection.
Resumen
La demora en el diagnóstico del VIH es un problema común. Nosotros planteamos la hipótesis de que las personas con menos confianza en los doctores y en el sistema de salud serán diagnosticadas con un conteo más bajo de células CD4 que las personas que tienen más confianza, porque retrasan el ir en busca de atención médica. De Enero del 2006 a Octubre del 2007, 171 personas infectadas con el virus del VIH, que nunca habían recibido atención médica para el VIH previamente fueron reclutadas en Houston, TX en lugares donde hacen la prueba del VIH y dan atención a las personas de bajos recursos sin seguro médico. Los participantes completaron cuestionarios que evaluaban la confianza en los doctores, y la confianza en el sistema de atención médica. El conteo inicial de las células CD4 fue obtenido revisando expedientes médicos. Las puntuaciones medias de la confianza de los participantes con un conteo de células CD4 ≥200cells/mm se compararon con las puntuaciones de los participantes con conteos de células CD4 <200 cells/mm. Encontramos que el 51% del grupo con estadísticas similares fue diagnosticado con un conteo de células CD4 <200 cells/mm. Ninguno, ni la confianza en los doctores o la confianza en el sistema de atención medica fueron predictores independientes del diagnóstico retardado de infección del VIH. En análisis de variantes múltiples, los hombres que tienen sexo con hombres y las personas que se inyectan drogas mostraron más probabilidades de tener una detección temprana de la infección del VIH. La raza/etnicidad fue la única variable estadísticamente significante, en la predicción de confianza en los doctores y en el sistema de salud. Los hispanos tuvieron los valores más altos, seguidos de negros y blancos. El tener baja confianza no parece ser una barrera para diagnosticar la infección del VIH oportunamente.
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Acknowledgments
Supported by NIMH grant R34MH074360, AHRQ Grant U18HS016093, the Baylor/UT Houston Center for AIDS Research grant P30AI036211, and the facilities and resources of the Harris County Hospital District and the Michael E. DeBakey VA Medical Center. Dr. Giordano is a researcher at the Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, Houston, TX. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
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Graham, J.L., Grimes, R.M., Slomka, J. et al. The Role of Trust in Delayed HIV Diagnosis in a Diverse, Urban Population. AIDS Behav 17, 266–273 (2013). https://doi.org/10.1007/s10461-011-0114-9
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DOI: https://doi.org/10.1007/s10461-011-0114-9