HIV outcomes for foreign-born patients receiving care at a safety net county health system in the southern US

Christine Pack, Joan Reisch, H

Abstract

BACKGROUND: Foreign-born Human Immunodeficiency Virus (HIV) infected patients receiving care in the US have complex factors affecting their care outcomes. METHODS: We analyzed viral suppression, CD4 count, and healthcare retention among foreign-born patients from non-Spanish speaking countries in a publicly funded health system in Dallas, Texas through a retrospective chart review from 2010 to 2016. RESULTS: Foreign-born patients had a viral suppression rate of 79.3%. Unsuppressed viral load, CD4 counts less than 200, and loss to care were significantly associated with higher emergency room (ER) visits and hospital admissions. Lack of healthcare coverage (excluding Ryan White coverage) and missed primary care appointments were significantly associated with unsuppressed viral load and loss to care. In multivariate logistic regression, having Ryan White coverage made one less likely to be lost to care than other health care coverage options (OR 0.309). CONCLUSION: This study revealed that, factors related to healthcare utilization like ER visits, hospital admissions, and lack of healthcare coverage had a negative impact on HIV outcomes rather than socio-cultural factors like region of origin or language. Ryan White coverage, a payer of last resort in Texas, was predictive of retention in care of foreign-born patients in this area.