Regional differences among HIV patients in care: California medical monitoring project sites, 2007-2008.

INTRODUCTION: The Medical Monitoring Project (MMP) is a national, multi-site population-based supplemental HIV/AIDS surveillance project of persons receiving HIV/AIDS care. We compared California MMP data by region. Demographic characteristics, medical care experiences, HIV treatment, clinical care outcomes, and need for support services are described. METHODS: HIV-infected patients 18 years or older were randomly selected from medical care facilities. In person structured interviews from 2007 - 2008 were used to assess sociodemographic characteristics, self-reported clinical outcomes, and need for supportive services. Pearson chi-squared, Fisher's exact and Kruskal-Wallis p-values were calculated to compare regional differences. RESULTS: Between 2007 and 2008, 899 people were interviewed: 329 (37%) in San Francisco (SF), 333 (37%) in Los Angeles (LA) and 237 (26%) in other California counties. Significant regional sociodemographic differences were found. Care received and clinical outcomes for patients in MMP were positive and few regional differences were identified. HIV case management (36%), mental health counseling (35%), and dental services (29%) were the supportive services patients most frequently needed. Unmet needs for supportive services were low overall. Significant differences by region in needed and unmet need services were identified. DISCUSSION: The majority of MMP respondents reported standard of care CD4 and viral load monitoring, high treatment use, undetectable HIV viral loads and CD4 counts indicative of good immune function and treatment efficacy. Information from MMP can be used by planning councils, policymakers, and HIV care providers to improve access to care and prevention. Identifying regional differences can facilitate sharing of best practices among health jurisdictions.

Behavioral and infectious disease risks in young blood donors: implications for recruitment.

BACKGROUND: Recruitment of young donors is critical to expand the donor base and sustain the blood supply. Nevertheless, there is concern that younger blood donors may have a higher risk profile than their older counterparts. STUDY DESIGN AND METHODS: The prevalence of behavioral risks associated with transfusion-transmissible viral infections and the incidence of viral markers were compared between younger and older donors. Behavioral risks included unreported deferrable risks (UDRs) and HIV test seeking estimated from anonymous donor surveys administered in 1993 and 1998. The incidence of HIV, HCV, or HBV was estimated from donors giving at five US blood centers between 1996 and 2000. RESULTS: Donors younger than 25 years of age were significantly more likely to report a UDR or HIV test seeking than those 25 years or older. ORs comparing donors 18 to 19 and 20 to 24 years of age to those 25 years or older were 2.0 (95% CI, 1.5-2.6) and 1.5 (95% CI, 1.2-1.9) for UDR and 4.5 (95% CI, 3.0-6.9) and 5.5 (95% CI, 4.2-7.1) for test seeking, respectively. Although incidence estimates did not significantly differ between age groups, HIV incidence appeared to be highest in 18- to 19-year-old donors, whereas HBV incidence was highest in 20- to 24-year-old donors. CONCLUSIONS: Donors younger than 25 years of age appeared to have a higher behavioral risk profile than older donors. The message not to donate when a behavioral risk is present or for obtaining HIV tests needs to be reinforced in younger donors.

Lapsed donors: an untapped resource.

BACKGROUND: There is a clear need for methods to recruit and retain donors without compromising blood safety. Although prior studies report lower viral prevalence rates in repeat donors than those in first-time donors, it is unknown if this relationship holds after a lapse of several years between donations. STUDY DESIGN AND METHODS: A total of 6.4 million allogeneic donations collected at five US blood centers from 1991 through 1998 were classified by donation history (first-time vs. repeat) and by length of time between donations (lapsed interval length). The prevalence of HCV, HIV, and HBsAg was compared by donation history and lapsed interval length. The relationship between lapsed interval length and donor demographics was explored. RESULTS: Repeat donors who delayed their return for over 5 years were significantly less likely to test positive for a viral infection than were first-time donors. The likelihood of a positive test result appeared to increase steadily with lapsed interval length for HCV and HBsAg, but not for HIV. Younger, less educated, and nonwhite donors were less likely to return than others. CONCLUSIONS: Recruitment of donors who have not returned for several years could be an effective way to increase the blood supply while preserving blood safety. Understanding the relationship of donor demographics to return behavior is important for recruitment efforts.