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255P

CLINICAL, DEMOGRAPHIC, AND HEALTH RESOURCE UTILIZATION CHARACTERISTICS OF HIV-INFECTED SUB-SAHARAN IMMIGRANTS AND REFUGEES FOLLOWED AT THE SOUTHERN ALBERTA CLINIC

H Krentz, J Gill
Southern Alberta Clinic/University of Calgary, Calgary, Alberta

Objective: To examine the sociodemographic, clinical and healthcare utilization characteristics of HIV-infected sub-Saharan immigrants/refugees followed within our regional HIV population.
Methods: All new patients followed at Southern Alberta Clinic between 1997-2004 were included and followed until lost-to-follow-up, death, or April 2004. Sub-Saharan immigrant/refugees are sorted by country of birth and immigration date. They are compared to a cohort of Canadian-born HIV-patients by demographic, clinical and healthcare utilization characteristics. Statistical analysis are conducted using SPSS with P<0.05 level of significance.
Results: 11% of 592 patients were born in sub-Saharan Africa. This proportion has increased from 6% in 1997 to 21% in 2004. They were more likely female (52%), <30 years (34%) and heterosexual (88%) (P<0.001). Median CD4 count at initial visit was 237/mm3 (IQR 123-415) compared to 338/mm3 (140-538) for Canadian-born patients. Sub-Saharan immigrants experienced the same rate of new opportunistic infections, however, none died compared with 36 deaths among Canadian-born patients (P<0.05). Immigrant tested positive for TB (23%) and toxoplasmosis (33%) more often than Canadian-born patients (4% and 8% respectively) (P<0.001). Immigrants had more clinic (1.16 vs 0.99 per 100/patient days (PD) followed) and lab visits (0.87 vs 0.77 per 100 PD) and spend more days in hospital (0.26 vs 0.19 per 100 PD) than Canadian patients (all P<0.05) but were hospitalized less often for non-HIV-related conditions. Median per patient per month costs (in-patient and out-patient) for immigrants were not significantly higher ($903) than that of Canadian-born patients.
Conclusion: The proportion of HIV-infected immigrants from developing nations will likely continue to increase in Canada. These individuals present in poorer health and with more comorbidities leading to greater utilization of healthcare resources, however, at the present time, the direct cost of care is similar.

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