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.

Kolman, Marc

DeCoster, Mary

Proeschold-Bell, Rae Jean

Hunter, Genevieve Ankeny

Bartlett, John

Seña, Arlene C

United States

2013-03-04T17:40:59Z

2011-11

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.

http://www.ncbi.nlm.nih.gov/pubmed/22523850

0029-2559

https://hdl.handle.net/10161/6322

eng

N C Med J

North Carolina Medical Journal

Adolescent

Adult

Coinfection

Female

Focus Groups

Geographic Information Systems

HIV Infections

Health Services Accessibility

Hepatitis B

Hepatitis C

Hepatitis, Viral, Human

Humans

Male

North Carolina

Patient Acceptance of Health Care

Sexually Transmitted Diseases

Viral Load

Young Adult

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.

Journal article

Proeschold-Bell, Rae Jean|0000-0003-2008-3053

6

72

http://www.ncbi.nlm.nih.gov/pubmed/22523850

439

446

6

Duke

Global Health Institute

Institutes and Provost's Academic Units

University Institutes and Centers

Published

72