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The increasing impact of human immunodeficiency virus infections, sexually transmitted diseases, and viral hepatitis in Durham County, North Carolina: a call for coordinated and integrated services.

dc.contributor.author Kolman, M
dc.contributor.author DeCoster, M
dc.contributor.author Proeschold-Bell, RJ
dc.contributor.author Hunter, GA
dc.contributor.author Bartlett, J
dc.contributor.author Seña, AC
dc.coverage.spatial United States
dc.date.accessioned 2013-03-04T17:40:59Z
dc.date.issued 2011-11
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/22523850
dc.identifier.issn 0029-2559
dc.identifier.uri http://hdl.handle.net/10161/6322
dc.description.abstract BACKGROUND: Durham County, North Carolina, faces high rates of human immunodeficiency virus (HIV) infection (with or without progression to AIDS) and sexually transmitted diseases (STDs). We explored the use of health care services and the prevalence of coinfections, among HIV-infected residents, and we recorded community perspectives on HIV-related issues. METHODS: We evaluated data on diagnostic codes, outpatient visits, and hospitalizations for individuals with HIV infection, STDs, and/or hepatitis B or C who visited Duke University Hospital System (DUHS). Viral loads for HIV-infected patients receiving care were estimated for 2009. We conducted geospatial mapping to determine disease trends and used focus groups and key informant interviews to identify barriers and solutions to improving testing and care. RESULTS: We identified substantial increases in HIV/STDs in the southern regions of the county. During the 5-year period, 1,291 adults with HIV infection, 4,245 with STDs, and 2,182 with hepatitis B or C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were coinfected with an STD or hepatitis B or C, respectively. In 2009, 65.7% of HIV-infected persons receiving care had undetectable viral loads. Barriers to testing included stigma, fear, and denial of risk, while treatment barriers included costs, transportation, and low medical literacy. LIMITATIONS: Data for health care utilization and HIV load were available from different periods. Focus groups were conducted among a convenience sample, but they represented a diverse population. CONCLUSIONS: Durham County has experienced an increase in the number of HIV-infected persons in the county, and coinfections with STDs and hepatitis B or C are common. Multiple barriers to testing/treatment exist in the community. Coordinated care models are needed to improve access to HIV care and to reduce testing and treatment barriers.
dc.language eng
dc.relation.ispartof N C Med J
dc.subject Adolescent
dc.subject Adult
dc.subject Coinfection
dc.subject Female
dc.subject Focus Groups
dc.subject Geographic Information Systems
dc.subject HIV Infections
dc.subject Health Services Accessibility
dc.subject Hepatitis B
dc.subject Hepatitis C
dc.subject Hepatitis, Viral, Human
dc.subject Humans
dc.subject Male
dc.subject North Carolina
dc.subject Patient Acceptance of Health Care
dc.subject Sexually Transmitted Diseases
dc.subject Viral Load
dc.subject Young Adult
dc.title The increasing impact of human immunodeficiency virus infections, sexually transmitted diseases, and viral hepatitis in Durham County, North Carolina: a call for coordinated and integrated services.
dc.type Journal article
duke.description.issue 6
duke.description.volume 72
dc.relation.journal North Carolina Medical Journal
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/22523850
pubs.begin-page 439
pubs.end-page 446
pubs.issue 6
pubs.organisational-group Duke
pubs.organisational-group Global Health Institute
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group University Institutes and Centers
pubs.publication-status Published
pubs.volume 72


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