Disparities in HIV care in Ontario

By Sally Robertson, B.Sc.Dec 20 2012

Researchers have found significant disparities in hospital admission rates for certain groups of individuals living with HIV in Ontario, Canada.

"Our findings have important clinical implications for researchers, clinicians and policy-makers involved in the provision of HIV-related care," they write in Open Medicine.

Persistent differences in the rates of total hospital admissions for certain individuals suggest an inadequacy in community-based health and social services that may render the most marginalized HIV-infected patients vulnerable to poor health outcomes, say Tony Antoniou (University of Toronto, Ontario) and team.

In Ontario, where important changes in the demographic composition of the population have been observed over the past decade, there is a lack of data on health services utilization that could aid provision, evaluation, and funding of HIV-related care. Using the Canadian Institute for Health Information Discharge Abstract Database, Antoniou and team assessed temporal trends in hospital admission rates among individuals with HIV in the province.

They found that between 1992 and 2009, crude annual rates of total hospital admissions decreased from 392.4 per 1000 persons with HIV, while HIV-related admission rates fell from 247.6 to 32.2 per 1000 persons with HIV.

However, the introduction of antiretroviral therapy in 1996 to 1997 had a more pronounced effect among men than among women for reducing both total hospital admissions and HIV-related admissions, at -89.9 versus -60.5 and -56.9 versus -36.3 per 1000 persons with HIV, respectively.

Between 2002 and 2009, the adjusted rates of total hospital admissions were a significant 15% higher among women than among men. The rates were also 21% higher among people living in low- versus high-income neighbourhoods.

Previously described barriers impeding access to HIV-related care among women include lack of transportation, depression, and history of physical or sexual abuse, note the researchers. In addition, women are more likely than men to delay initiation of antiretroviral therapy possibly due to concern about disclosing their HIV status to children, socioeconomic circumstances, and family commitments that often include women assuming the role of primary caregiver to other family members living with HIV.

Regarding people from low-income neighbourhoods who have HIV, unstable housing status and food security have been documented to undermine adherence to therapy and to contribute to poor health outcomes in these individuals.

Antoniou and team also report that recent immigration was associated with lower rates of hospital admission, a finding which should be investigated further, they say.

"Continued collaborations among the community of people living with HIV, researchers, clinicians and policy makers will be essential to generate the qualitative and quantitative data required to elicit and address the social and structural factors modifying access to care among people living with HIV," concludes the team.

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