|
Childhood sexual abuse history affects HIV primary care utilization
A. Woodruff, S. Napravnik, E.S. Brouwer, B. Stalzer, J.J. Eron
University of North Carolina at Chapel Hill, Center for AIDS Research, Chapel Hill, United States
Background: Childhood sexual abuse (CSA) is prevalent among HIV-infected women and may affect clinical outcomes. Therefore we assessed the effect of CSA on patterns of HIV primary care utilization among women in the Southeastern U.S.
Methods: Women enrolled in an HIV observational clinical cohort, meeting current guidelines for antiretroviral therapy (ART) initiation and completing an in-person interview assessing CSA, were included. We calculated number of clinic visits per year (scheduled, walk-in and missed visits). Multivariable Poisson regression analyses were used to estimate the effect of CSA on clinic visits per year, adjusting for possible socio-demographic and clinical characteristics.
Results: The 107 women included in this study were 77% African American, a median of 49 years of age (IQR: 41, 54), and contributed 685 person-years of follow-up. CSA was reported by 21% (95% CI: 13%, 29%). Patients on average attended 3.06 scheduled visits per year (95% CI: 2.85, 3.26), 1.31 walk-in visits per year (95% CI: 0.99, 1.63), and missed 0.97 visits per year (95% CI: 0.80, 1.14). In multivariable analyses CSA history did not significantly affect scheduled visits attended or missed visits (IRR=1.00; 95% CI: 0.75,1.33; IRR=1.30; 95% CI: 0.81, 2.08, respectively). Patients with CSA histories attended a greater number of walk-in visits (1.80 visits per year versus 1.18 visits per year, P=0.02). This association remained after adjustment for a number of factors including psychiatric comorbidity, substance abuse, CD4 cell count, and HIV RNA level; IRR adjusted=1.80 (95% CI: 1.22,2.67).
Conclusions: Although CSA history did not affect scheduled visit attendance and may not affect the frequency of missed visits, it was associated with greater walk-in visits. A history of mental illness or substance abuse, frequently associated with CSA, did not affect this relationship. Reasons contributing to unscheduled visits need to be understood as does the impact of CSA on HIV clinical outcomes.
|