BACKGROUND: Patients who are diagnosed late in the course of HIV infection are at an increased risk of transmitting HIV to others. They are also at risk for worse health outcomes and greater medical expenses.
METHODS: The data set included all persons diagnosed with HIV in Riverside County, California between 2009 and 2014 and entered into the Enhanced HIV/AIDS Reporting System (eHARS) by June, 2015. Late testers were persons diagnosed with AIDS within 12 months of their HIV diagnosis. The Chi-square was used to test if an association exists between sociodemographic variables and testing late and Odds Ratios were calculated to measure the associations identified by the Chi-square test. Independent predictors of late testing were measured using multivariate logistic regression.
RESULTS: Of the 1,385 cases included in the analysis, 422 (30.5%) were late testers. Factors that were independently associated with an increased likelihood of testing late were having no insurance (Exp (B) = 1.938, p=0.005), being Hispanic (Exp (B) = 1.651, p=0.002) and being between the ages of 45-64 (Exp (B) = 1.722, p=0.0001). These respondents were nearly twice as likely to test late. Females (Exp (B) = -0.650, p-0.013) and those residing in the eastern region of the county (Exp (B) = -0.472, p=0.002) had a decreased likelihood of late testing.
CONCLUSIONS: Although free, confidential testing is available throughout Riverside County, approximately one-third (30.5%) of new HIV diagnoses in this study received an AIDS diagnosis within 12 months indicating they were diagnosed late in the disease process. Similar to previous research this study found increased risk among those who were older (45 – 64 years old), and the uninsured. Additionally, there was an increased risk among Hispanics but not among other racial/ethnic minorities. The analysis also found reduced risk among women and those who live in the eastern part of the County. The reduced risk in the eastern part of the county is particularly interesting since over 60% of all persons living with HIV/AIDS in Riverside County live in this region. Because of this, this region also has the most extensive HIV education and testing programs which may be contributing to the reduced risk of late testing. Though other studies have shown an increased risk for heterosexual males and decreased risk for men who have sex with men and injection drug users, this study did not find an independent association between mode of HIV transmission and late to test.