Linkage to HIV care and its determinants in the late HAART era: a systematic review and meta-analysis

Abstract

Poor engagement into HIV care limits the effectiveness of highly active antiretroviral therapies (HAART) to improve survival and reduce transmission. The design of effective interventions to enhance linkage to care is dependent on evidence about rates of entry into HIV care. This is a systematic review and meta-analysis on linkage measurement and its determinants in the late era of HAART (post-2003), in high-income countries. We searched the PubMed and Web of Science databases, restricting our sample to the late HAART era (post-2003) until February 2016, and to high-income countries. We retained only studies that produced quantified outcomes. We rejected the studies with a high risk of bias, and followed a standard meta-analytic approach. Because there was a high heterogeneity ( I > 90%), the aggregated findings were based on a random-effects model. A total of 43 studies were identified, all of them following a cohort of patients newly diagnosed until referred to specialized care. For a one-month period, the meta-proportion was 71.1% (IC95%: 61.0%-81.2). For a three-month duration, the meta-proportion of linkage to care was 77.0% (IC95%: 75.0%-79.0). For a one-year period, the meta-proportion was 76.3% (IC95%: 54.2%-98.4%). The proportions were lower when lab tests were used as referral indicator, with a pooled meta-proportion of 76.7% (IC95%: 73.0%-80.4), in comparison to a value of 80.8% (IC95%: 68.7%-92.9) for consultations. Being black or male were the most commonly observed determinants of delayed entry into care. Young people, injecting drug users, people with low socioeconomic status, or at a less advanced stage of disease also experienced lower proportions of timely linkage. Timely engagement into care is below 80% and specific sub-groups are particularly at risk of late entry. These findings confirm earlier evidence that linkage to care remains low, and that efforts should focus on vulnerable populations.

Ending the HIV epidemic in the USA: an economic modelling study in six cities

“…If sufficient scale can be reached, partner services, in particular, might be effective. 27,28 Other interventions with a more limited evidence base include testing in non-health-care settings, 29 particularly self-testing; 30,31 PrEP for people who inject drugs 32 and heterosexuals at high risk of infection; 33 testing in correctional settings 34 and transitional care support, 35 linkage to care programmes, 36 and low-barrier care delivery; 37 and e-health solutions to improve ART persistence. 38,39 Furthermore, we focused on evidencebased interventions, while remaining agnostic about the capacity or specific circumstances of public health departments.…”

HIV treatment, antiretroviral adherence and AIDS mortality in people who inject drugs: a scoping review

“…Almost half (21/43) of the included studies included data on PWID. 17 Injecting drug use (IDU) was significantly associated with delayed linkage, with a risk of up to two times greater compared to non-PWID. Furthermore, mental illness and having hepatitis B or C were also associated with delayed entry into HIV care.…”

Promoting HIV care continuum outcomes among people who use drugs and alcohol: A systematic review of randomized trials published from 2011 to 2021

“…After removing duplicates, we used the same software to subject the remaining 4999 articles to screening based on the aforementioned criteria. As part of our review process, we identified 19 articles that were systematic reviews of the literature about HIV and substance use and therefore relevant to the topic of this review (Abebe Moges, Olubukola, Micheal, & Berhane, 2020; Ahmed et al, 2018; Arrivillaga, Martucci, Hoyos, & Arango, 2013; Bazzi et al, 2019; Casale, Carlqvist, & Cluver, 2019; Feelemyer, Des Jarlais, Arasteh, & Uusküla, 2015; Glick et al, 2020; Govindasamy, Ford, & Kranzer, 2012; Hudelson & Cluver, 2015; Larney et al, 2017; Locher, Messerli, Gaab, & Gerger, 2019; Low et al, 2016; Mistler, Copenhaver, & Shrestha, 2021; Nachega et al, 2012; Nguemo Djiometio et al, 2020; Paquette & Pollini, 2018; Perelman, Rosado, Ferro, & Aguiar, 2018; Uthman, Oladimeji, & Nduka, 2017; Velloza et al, 2020). We examined these articles and their reference lists and found no additional studies in the reference lists that met our inclusion criteria.…”