Melanie Gwynn

Date of Award

Fall 2019

Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Janice Probst


Background: On the HIV/AIDS care continuum, the “retention in care” metric does not distinguish between single-facility (SF) or multi-clinic utilization (MC), also described as HIV care location (or type). SF utilization is vital as it has been linked optimal clinical outcomes among People Living with HIV/AIDS (PLWH). Published research detailing the prevalence of HIV care type and its association with health outcomes/clinical indicators, has been studied only in limited urban settings. Additionally, coinfections such as sexually transmitted infections (STIs), have yet to be evaluated as potential predictive factors for HIV care type.

Methods: A cross-sectional design was used to evaluate data from South Carolina enhanced HIV/AIDS Reporting System (SC e-HARS) merged with data from South Carolina Sexually Transmitted Diseases Management Information System (STD*MIS), during 2014-2017 to 1) determine: the prevalence of single versus multi-facility HIV care location and STI coinfection, the association between HIV care location and STI coinfection, and 2) the association between HIV care location and patient health outcomes and clinical indicators.

Results: 1) From 2014-2017, the proportion of patients receiving SF care ranged from 42%-71%. The factors significantly associated with HIV care type included year of diagnosis (p=

syphilis being the most frequently reported STI. In contrast to STIs, the prevalence of opportunistic infections (OIs) was much lower ranging from 2.57% to 6.99%. The most prevalent OIs were esophageal candidiasis and PCP. STIs were predictors of lower odds of SF in years 2015 (AOR 0.582, 95% CI 0.410-0.826), 2016 (AOR 0.586, 95% CI

0.438-0.785), and 2017 (AOR 0.640, 95% CI 0.489-0.838).

2) Of the sample of persons retained in care during 2016, 88.2% (n=1431) had viral load labs in 2017 and 86% (n=1396) had CD4 lab values. SF HIV care was not a predictor of viral suppression in the subsequent year (OR 0.989, [95% CI 0.722-1.355]; AOR 1.015, [95% CI 0.728-1.414]). However, SF HIV care in 2016 was a predictor of better CD4 control (value ≥ 350 ml) in 2017 in both our unadjusted and adjusted models (OR 0.696, 95% [CI 0.532-0.910]; AOR 0.676, 96% [CI 0.510-0.896]).

Available for download on Thursday, December 16, 2021