Table 3.
Linkage to HIV medical care a within 1 month of HIV diagnosis, by health insurance coverage in county of residence among adults aged ≥18, by sex at birth and selected characteristics, 41 states b and the District of Columbia, 2017 c
| Characteristic | Residence in counties where ≥12% of population lacks health insurance | Residence in counties where <12% of population lacks health insurance | Prevalence ratio d (95% CI) | ||||
|---|---|---|---|---|---|---|---|
| Total diagnoses, no. | Linked to care within 1 month, no. (%) | Not linked to care within 1 month, no. (%) | Total diagnoses, no. | Linked to care within 1 month, no. (%) | Not linked to care within 1 month, no. (%) | ||
| Males | |||||||
| Age at diagnosis, y | |||||||
| 18-24 | 4121 | 2993 (72.6) | 1128 (27.4) | 1916 | 1508 (78.7) | 408 (21.3) | 0.92 (0.90-0.95) |
| 25-34 | 6713 | 5082 (75.7) | 1631 (24.3) | 3302 | 2662 (80.6) | 640 (19.4) | 0.94 (0.92-0.96) |
| 35-44 | 3324 | 2609 (78.5) | 715 (21.5) | 1598 | 1356 (84.9) | 242 (15.1) | 0.92 (0.90-0.95) |
| 45-54 | 2373 | 1871 (78.8) | 502 (21.2) | 1279 | 1111 (86.9) | 168 (13.1) | 0.91 (0.88-0.94) |
| ≥55 | 1498 | 1215 (81.1) | 283 (18.9) | 804 | 666 (82.8) | 138 (17.2) | 0.98 (0.94-1.02) |
| Race/ethnicity | |||||||
| American Indian/Alaska Native | 93 | 74 (79.6) | 19 (20.4) | 28 | 27 (96.4) | 1 (3.6) | 0.83 (0.73-0.94) |
| Asian | 400 | 310 (77.5) | 90 (22.5) | 348 | 298 (85.6) | 50 (14.4) | 0.91 (0.85-0.97) |
| Black/African American | 7392 | 5428 (73.4) | 1964 (26.6) | 3223 | 2491 (77.3) | 732 (22.7) | 0.95 (0.93-0.97) |
| Hispanic/Latino e | 5590 | 4323 (77.3) | 1267 (22.7) | 1848 | 1573 (85.1) | 275 (14.9) | 0.91 (0.89-0.93) |
| Native Hawaiian/Other Pacific Islander | 15 | 12 (80.0) | 3 (20.0) | 18 | 16 (88.9) | 2 (11.1) | 0.90 (0.67-1.22) |
| White | 4126 | 3293 (79.8) | 833 (20.2) | 3120 | 2644 (84.7) | 476 (15.3) | 0.94 (0.92-0.96) |
| Multiple races | 413 | 330 (79.9) | 83 (20.1) | 314 | 254 (80.9) | 60 (19.1) | 0.99 (0.92-1.06) |
| Transmission category f | |||||||
| Male-to-male sexual contact | 15 064 | 11 553 (76.7) | 3510 (23.3) | 7198 | 5943 (82.6) | 1255 (17.4) | 0.93 (0.92-0.94) |
| Injection drug use | 571 | 425 (74.4) | 146 (25.6) | 496 | 390 (78.7) | 106 (21.3) | 0.95 (0.89-1.01) |
| Male-to-male sexual contact and injection drug use | 618 | 445 (72.1) | 173 (27.9 | 477 | 381 (80.0) | 95 (20.0) | 0.90 (0.84-0.96) |
| Heterosexual contact g | 1761 | 1334 (75.8) | 427 (24.2) | 719 | 581 (80.8) | 138 (19.2) | 0.94 (0.90-0.98) |
| Other h | 16 | 13 (80.1) | 3 (19.9) | 10 | 8 (79.4) | 2 (20.6) | 1.01 (0.67-1.51) |
| County of residence at diagnosis (population) | |||||||
| Metropolitan (≥500 000) | 14 627 | 11 168 (76.4) | 3459 (23.6) | 7314 | 6050 (82.7) | 1264 (17.3) | 0.92 (0.91-0.94) |
| Urban (50 000-499 999) | 2245 | 1709 (76.1) | 536 (23.9) | 1159 | 915 (78.9) | 244 (21.1) | 0.96 (0.93-1.00) |
| Rural (<50 000) | 1157 | 893 (77.2) | 264 (22.8) | 426 | 338 (79.3) | 88 (20.7) | 0.97 (0.92-1.03) |
| Subtotal | 18 029 | 13 770 (76.4) | 4259 (23.6) | 8899 | 7303 (82.1) | 1596 (17.9 | 0.93 (0.92-0.94) |
| Females | |||||||
| Age at diagnosis, y | |||||||
| 18-24 | 565 | 419 (74.2) | 146 (25.8) | 253 | 208 (82.2) | 45 (17.8) | 0.90 (0.84-0.97) |
| 25-34 | 1154 | 883 (76.5) | 271 (23.5) | 572 | 479 (83.7) | 93 (16.3) | 0.91 (0.87-0.96) |
| 35-44 | 965 | 730 (75.6) | 235 (24.4) | 511 | 410 (80.2) | 101 (19.8) | 0.94 (0.89-0.99) |
| 45-54 | 807 | 640 (79.3) | 167 (20.7) | 425 | 358 (84.2) | 67 (15.8) | 0.94 (0.89-0.99) |
| ≥55 | 649 | 499 (76.9) | 150 (23.1) | 375 | 334 (89.1) | 41 (10.9) | 0.86 (0.82-0.91) |
| Race/ethnicity | |||||||
| American Indian/Alaska Native | 27 | 24 (88.9) | 3 (11.1) | 9 | 8 (88.9) | 1 (11.1) | 1.00 (0.77-1.31) |
| Asian | 52 | 35 (67.3) | 17 (32.7) | 45 | 38 (84.4) | 7 (15.6) | 0.80 (0.64-1.00) |
| Black/African American | 2605 | 1995 (76.6) | 610 (23.4) | 1190 | 1000 (84.0) | 190 (16.0) | 0.91 (0.88-0.94) |
| Hispanic/Latino e | 682 | 535 (78.4) | 147 (21.6) | 276 | 231 (83.7) | 45 (16.3) | 0.94 (0.88-1.00) |
| Native Hawaiian/Other Pacific Islander | 5 | 3 (60.0) | 2 (40.0) | 5 | 5 (100.0) | 0 | — |
| White | 690 | 518 (75.1) | 172 (24.9) | 540 | 447 (82.8) | 93 (17.2) | 0.91 (0.86-0.96) |
| Multiple races | 79 | 61 (77.2) | 18 (22.8) | 71 | 60 (84.5) | 11 (15.5) | 0.91 (0.78-1.07) |
| Transmission category f | |||||||
| Injection drug use | 457 | 344 (75.1) | 114 (24.9) | 384 | 303 (78.9) | 81 (21.1) | 0.95 (0.88-1.03) |
| Heterosexual contact g | 3669 | 2817 (76.8) | 852 (23.2) | 1739 | 1475 (84.8) | 265 (15.2) | 0.91 (0.88-0.93) |
| Other h | 14 | 10 (75.7) | 3 (24.3) | 13 | 12 (90.6) | 1 (9.4) | 0.84 (0.59-1.18) |
| County of residence at diagnosis | |||||||
| Metropolitan (≥500 000) | 3198 | 2435 (76.1) | 763 (23.9) | 1785 | 1503 (84.2) | 282 (15.8) | 0.90 (0.88-0.93) |
| Urban (50 000-499 999) | 627 | 493 (78.6) | 134 (21.4) | 267 | 223 (83.5) | 44 (16.5) | 0.94 (0.88-1.01) |
| Rural (<50 000) | 315 | 243 (77.1) | 72 (22.9) | 84 | 63 (75.0) | 21 (25.0) | 1.03 (0.90-1.18) |
| Subtotal | 4140 | 3171 (76.6) | 969 (23.4) | 2136 | 1789 (83.8) | 347 (16.2) | 0.91 (0.89-0.94) |
| Total | 22 169 | 16 941 (76.4) | 5228 (23.6) | 11 035 | 9092 (82.4) | 1943 (17.6) | 0.93 (0.92-0.94) |
aLinkage to HIV medical care was measured by documentation of ≥1 CD4+ T-lymphocyte test or ≥1 viral load test ≤1 month after HIV diagnosis. Of 38 381 people with HIV diagnosed in 2017, 33 204 met inclusion criteria for this analysis.
bAlabama, Alaska, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
cData source: Cohen et al. 21
dCompares percentage linked to care within 1 month of HIV diagnosis.
eHispanic/Latino can be of any race.
fData were adjusted to account for missing data on transmission category; therefore, values may not sum to column total.
gHeterosexual contact with a person known to have or to be at high risk for HIV infection.
hIncludes people whose infection was attributed to hemophilia blood transfusion or perinatal exposure or whose risk factor was not reported or identified.