Term of Award

Fall 2013

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Department

Jiann-Ping Hsu College of Public Health

Committee Chair

Gulzar H. Shah

Committee Member 1

Gregory Evans

Committee Member 2

Renee Hotchkiss

Committee Member 3

Susan Alt

Committee Member 3 Email

sealt@dhr.state.ga.us

Abstract

BACKGROUND: Staying in the medical care is essential for HIV patients to benefit from life-saving treatment. There are limited data on predictors of retention in HIV care from rural areas of Georgia. In the Coastal CARE Centers (CCC) located in the Coastal Health District, a substantial number of HIV patients are lost to follow-up (LTFU).

METHODOLOGY: We extracted data from the electronic medical record for HIV/AIDS patients who had attended the CCC for their medical care between January 1, 2006 and October 30, 2012. We then matched the dataset with eHARS to determine those who met the criteria of LTFU for HIV care (absence of CD4, viral load, and ART for 12 months). Using logistic regression analysis, we assessed demographic and clinical factors associated with LTFU for HIV care.

RESULTS: Factors associated with LTFU in the CCC were: being black/African American versus White/non-Hispanic (OR = 12.269, 95% CI: 9.034 to16.663); Being over 50 years old was three times more likely to be LTFU compared to ≤ 19 years. Having viral load < 75 copies was 2 times more likely to be LTFU compared to those with viral load 10000-99999 copies. Having CD4 Count ≥ 500 cells/mm3 (OR = 2.820, 95% CI: 1.928 to 4.123) was more likely to drop out compared to CD4 < 200 cells/mm3.

CONCLUSION: Study of factors associated with LTFU can be used to identify patients at risk, and design strategies to improve retention as well as reducing HIV transmission in the Coastal Health District, Georgia.

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