Factors associated with delayed linkage to care following <scp>HIV</scp> diagnosis in the <scp>WHO</scp> European Region

Croxford, Sara; Burns, Fiona; Copas, Andrew; Pharris, Anastasia; Stengaard, Annemarie Rinder; Delpech, Valérie; Europe, OptTEST by Hiv in

doi:10.1111/hiv.12585

Cited by 10 publications

(10 citation statements)

References 13 publications

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“…Lack of association with sex confirms findings of other research, 35,38 although association has been seen in some settings. 34,39–41 Lack of association with formal education level, however, is in contrast to findings by other studies. 6 This may be because of the many years of widespread HIV sensitization programs in Uganda and Kenya, which have increased overall knowledge and awareness about HIV to all regardless of educational level.…”

Section: Discussioncontrasting

confidence: 99%

“…Our analysis of factors associated with failure to link to care identified some of the most difficult to engage subgroups including young adults. In agreement with other studies, 6,26,27,34 being young was associated with a lower likelihood of linking to care at all 3 time points evaluated; other studies have, however, shown conflicting findings with older individuals having lower linkage rates. 35 Individuals working in high-HIV-risk occupations such as fishing and transportation were also less likely to link possibly due to the mobile nature of these occupations, rigid work-time schedules, and the high levels of HIV-associated stigma within these subgroups.…”

Section: Discussionsupporting

confidence: 91%

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A Patient-Centered Multicomponent Strategy for Accelerated Linkage to Care Following Community-Wide HIV Testing in Rural Uganda and Kenya

Ayieko

Petersen

Charlebois

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction: As countries move toward universal HIV treatment, many individuals fail to link to care after diagnosis of HIV. Efficient and effective linkage strategies are needed. Methods: We implemented a patient-centered, multicomponent linkage strategy in the SEARCH "test-and-treat" trial (NCT 01864603) in Kenya and Uganda. After population-based, community-wide HIV testing, eligible participants were (1) introduced to clinic staff after testing, (2) provided a telephone "hot-line" for enquiries, (3) provided an appointment reminder phone call, (4) given transport reimbursement on linkage, and (5) tracked if linkage appointment was missed. We estimated the proportion linked to care within 1 year and evaluated factors associated with linkage at 7, 30, and 365 days after diagnosis. Results: Among 71,308 adults tested, 6811 (9.6%) were HIVinfected; of these, 4760 (69.9%) were already in HIV care, and 30.1% were not. Among 2051 not in care, 58% were female, median age was 32 (interquartile range 26-40) years, and median CD4 count was 493 (interquartile range 331-683) cells/mL. Half (49.7%) linked within 1 week, and 73.4% linked within 1 year. Individuals who were younger [15-34 vs. .35 years, adjusted Risk Ratio (aRR) 0.83, 95% confidence interval (CI): 0.74 to 0.94], tested at home vs. community campaign (aRR = 0.87, 95% CI: 0.81 to 0.94), had a high HIV-risk vs. low-risk occupation (aRR = 0.81, 95% CI: 0.75 to 0.88), and were wealthier (aRR 0.90, 95% CI: 0.83 to 0.97) were less likely to link. Linkage did not differ by marital status, stable residence, level of education, or having a phone contact. Conclusions: Using a multicomponent linkage strategy, high proportions of people living with HIV but not in care linked rapidly after HIV testing.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

A Patient-Centered Multicomponent Strategy for Accelerated Linkage to Care Following Community-Wide HIV Testing in Rural Uganda and Kenya

Ayieko

Petersen

Charlebois

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…These low numbers of IDUs do not allow for an in‐depth analysis of the factors related to the delayed care in this significant group of patients. IDUs usually start therapy at a late stage of infection, despite having received an earlier diagnosis, due to problems with linkage to care (objective and subjective barriers) [30]. These results warrant further research of the issue of LP among IDUs, including better linkage and the removal of barriers for everyone who tests positive.…”

Section: Discussionmentioning

confidence: 99%

Acquired immune deficiency syndrome (AIDS) and late presentation in Poland – data from Test and Keep in Care (TAK) Polska project

et al. 2021

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Objectives Late presentation (LP) at HIV diagnosis is associated with worse prognosis and an increase in the number of new infections. We analyse the proportion of patients diagnosed late and factors related to LP in Poland in 2016–2017. Methods Data were obtained from 13 out of 17 HIV centres in Poland from 2016 and 2017, including date of diagnosis, age, sex, transmission route, anti‐hepatitis C virus (anti‐HCV), Venereal Diseases Research Laboratory (VDRL) antibodies, AIDS diagnosis, baseline HIV viral load and CD4 count. Results Out of 1522 patients, 88.9% were male with median age of 33.6 years. Men who have sex with men (MSM) comprised 69.4% of all new infections, heterosexual route of transmission (HTX) 18.2% and injecting drug use (IDU) 4.7%. Late presenters comprised 44.8% of the study group. Factors associated with LP were female sex [odds ratio (OR) = 1.5, 95% confidence interval (95% CI): 1.09–2.08], older age (OR = 1.59, 95% CI: 1.42–1.79 per decade), route of transmission (HTX: OR = 1.96, 95% CI: 1.50–2.56; IDU: OR = 3.17, 95% CI: 1.92–5.37), positive HCV results (OR = 1.90, 95% CI: 1.23–2.95) and syphilis diagnosis (OR = 2.06, 95% CI: 2.29–3.31). Adjusting for these factors, the only independent factors associated with LP were age (OR = 1.52, 95% CI: 1.35–1.71) and route of transmission (HTX: OR = 1.73, 95% CI: 1.23–2.44; IDU: OR = 2.24, 95% CI: 1.25–4.10). Conclusions Late presentation in Poland follows European trends. A total of 44.8% of all newly diagnosed patients in Poland continue to present late or at the AIDS stage. Independent factors associated with LP/AIDS were older age, IDU and HTX. Patients from these groups should be targeted to improve early diagnosis and medical care.

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“…Of note, 35% of patients generating an HIE alert were admitted to the hospital, compared with an average admission rate of 22% at Grady in 2017. This higher rate of hospital admission likely reflects the clinical acuity of patients generating HIE alerts, and this too has been associated in the past with linkage to care [21]. As a whole, this trend suggests that more intensive linkage interventions may lead to improved linkage outcomes.…”

Section: Discussionmentioning

confidence: 99%

Health Information Exchange: A Novel Re-linkage Intervention in an Urban Health System

Sharp

Angert

Mcconnell

et al. 2019

Open Forum Infectious Diseases

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Background Public health information exchanges (HIEs) link real-time surveillance and clinical data and can help to re-engage out-of-care people with HIV (PWH). Methods We conducted a retrospective cohort study of out-of-care PWH who generated an HIE alert in the Grady Health System (GHS) Emergency Department (ED) between January 2017 and February 2018. Alerts were generated for PWH who registered in the GHS ED without Georgia Department of Public Health (GDPH) CD4 or HIV-1 RNA in the prior 14 months. The alert triggered a social work (SW)–led re-linkage effort. Multivariate logistic regression analyses used HIE-informed SW re-linkage efforts as the independent variable, and linkage to care and 3- and 6-month viral suppression (HIV-1 RNA < 200 c/mL) as primary outcomes. Patients admitted to the hospital were excluded from primary analysis. Results One hundred forty-seven out-of-care patients generated an alert. Ninety-eight were included in the primary analysis (mean age [SD], 41 ± 12 years; 70% male; 93% African American), and 20 received the HIE-informed SW intervention. Sixty percent of patients receiving the intervention linked to care in 6 months, compared with 35% who did not. Patients receiving the intervention were more likely to link to care (adjusted risk ratio [aRR], 1.63; 95% confidence interval [CI], 0.99–2.68) and no more likely to achieve viral suppression (aRR, 1.49; 95% CI, 0.50–4.46) than those who did not receive the intervention. Conclusions An HIE-informed, SW-led intervention systematically identified out-of-care PWH and may increase linkage to care for this important population. HIEs create an opportunity to intervene with linkage and retention strategies.

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Factors associated with delayed linkage to care following HIV diagnosis in the WHO European Region

Abstract: Among those with CD4 data available, linkage to care is prompt. However, HIV surveillance must be strengthened and data quality improved, particularly in Eastern Europe. Our findings highlight disparities in care access and significant differences between regions.

Cited by 10 publications

References 13 publications

A Patient-Centered Multicomponent Strategy for Accelerated Linkage to Care Following Community-Wide HIV Testing in Rural Uganda and Kenya

A Patient-Centered Multicomponent Strategy for Accelerated Linkage to Care Following Community-Wide HIV Testing in Rural Uganda and Kenya

Acquired immune deficiency syndrome (AIDS) and late presentation in Poland – data from Test and Keep in Care (TAK) Polska project

Health Information Exchange: A Novel Re-linkage Intervention in an Urban Health System

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