Papers Published

  1. Kolman, M., DeCoster, M., Proeschold-Bell, R.J., Ankeny, G., Bartlett, J., & Seña, A.C., The increasing impact of HIV infections, sexually transmitted diseases and viral hepatitis in Durham County, North Carolina: A call for coordinated and integrated services, North Carolina Medical Journal, vol. 72 no. 6 (2012), pp. 439-446
    (last updated on 2012/05/02)

    Abstract:
    Background: Durham, North Carolina faces high rates of HIV/AIDS and sexually transmitted diseases (STDs). We explored the healthcare utilization of HIV-infected residents, co-infections, and community perspectives on HIV-related issues. Methods: From 2004-2008, we evaluated diagnostic codes, outpatient visits and hospitalizations for individuals with HIV, STDs, and/or hepatitis B/C at Duke University Hospital System (DUHS). Viral loads for HIV-infected patients in care were estimated for 2009. We conducted geospatial mapping to determine disease trends, and 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/C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were co-infected with an STD or hepatitis B/C, respectively. In 2009, 65.7% of HIV-infected persons in 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 healthcare utilization and HIV viral load were available from different time periods. Focus groups were conducted among a convenience sample, but represented a diverse population. Conclusion: Durham has experienced an increase in the number of HIV-infected persons in the county, and co-infections with STDs and hepatitis B/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.


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