Factors associated with utilization of HAART amongst hard-to-reach HIV-infected individuals in Atlanta, Georgia.

The study is aimed at identifying clinical, demographic and behavioral factors, including participation in HIV care, associated with the utilization of antiretroviral therapy (ART), among hard-to-reach HIV-positive individuals in Atlanta, GA. The study included 184 HIV-positive participants of the Infectious Disease Program (IDP) of the Grady Health System between February 1999 to March 2001. Individuals were categorized as regular attendees (those who consistently kept their outpatient appointments, n = 65), irregular (those who inconsistently kept their appointments, n = 60) or non-attendees (those who failed routinely to keep their appointments, n = 59). Univariate and multivariate analyses using log-binomial regression modeling were done. HIV-infected individuals who consistently kept their appointments at the IDP received ART at a frequency (86%) that is twice that of those who missed some appointments (42%) and four times that of those who routinely failed to keep appointments (20%). In multivariate analysis, category of clinic attendance (regular, irregular or non-attendee) was the only risk factor independently associated with utilization of ART: Regular attendees (RR = 3.59, 95% CI 2.12 to 6.08) and irregular attendees (RR = 2.26, 95% CI 1.28 to 4.01) compared to non-attendees. The positive association between routine clinic attendance and use of antiretroviral therapy observed in this study should encourage the development of strategies to retain patients in outpatient HIV care.