Predictors of time to enter medical care after a new HIV diagnosis: a statewide population-based study

Abstract

Public health benefits of expanded HIV screening will be adequately realized only if an early diagnosis is followed by prompt linkage to care. We characterized rates and factors associated with failure to enter into medical care within three months of HIV diagnosis and assessed the predictors of time to enter care over a follow-up period of up to 60 months. The study cohort included 3697 South Carolina (SC) residents' ≥13 years who were newly HIV-diagnosed in 2004-2008. Date of first laboratory report of CD4(+) T-cell count or viral load (VL) test after 30 days of confirmatory HIV diagnosis was used to define time to linkage to care. Results showed that of the total 3697 persons, 1768 (48%) entered care within three months, 1115 (30%) in four-12 months after diagnosis, and 814 (22%) failed to initiate care within 12 months of HIV diagnosis. At the end of study follow-up period of up to 60 months from the date of HIV diagnosis, 472/3697 (13%) individuals remained out of care. Multivariable Cox proportional hazards analysis showed that compared with hospitals, time to enter care was shorter in those diagnosed at state mental health/correctional facilities (adjusted hazards ratio [aHR] 1.16; 95% confidence interval [CI] 1.02-1.34) and longer in those diagnosed at county health departments (aHR 0.87; 95% CI 0.80-0.96) and at "Other/unknown" facilities (aHR 0.79; 95% CI 0.70-0.89). Time to entry into care was longer for men (aHR 0.82; 95% CI 0.75-0.89) compared with women, blacks (aHR 0.91; 95% CI 0.83-0.98) compared with whites, and males who have sex with males (MSM) (aHR 0.89; 95% CI 0.80-0.98) compared with heterosexual exposure. Delayed entry into HIV care remains a challenge in controlling HIV transmission in SC. Better integration of testing and care facilities could improve the proportion of newly HIV-diagnosed persons who enter care in a timely manner.

Disparities in Viral Load and CD4 Count Trends Among HIV-Infected Adults in South Carolina

“…13 Further, recent studies on retention in HIV care found that a large proportion of PLWHA in SC failed to remain in care on a regular basis. [14][15][16] These trends may be due in part to provider attitudes and practices regarding HIV testing and linkage to care, as HIV screening, early diagnosis, entry, and retention in care are important components relating to disparities in HIV outcomes. 17 Given the HIV burden in SC and the need to focus on retention in HIV care within the context of the National HIV/AIDS Strategy goals, 18 it is important to assess the trends in VL using statewide data.…”

Performance of a parallel diagnostic algorithm for HIV diagnosis in low risk pediatric and obstetric patient populations

“…Rapid and accurate diagnosis of Human Immunodeficiency Virus (HIV) infection is critical for patient management, reduction of mortality and prevention of forward transmission [1]. For the past two decades the diagnosis of HIV infection has been based on a testing algorithm that included an initial screen using an enzyme immunoassay (EIA) followed by confirmatory testing with either a Western blot (WB), or an indirect immunofluorescence assay (IFA) [2][3][4][5][6].…”

Case Management: Steadfast Resource for Addressing Linkage to Care and Prevention With Hospitalized HIV-Infected Crack Users

“…However, it has also been recognized that there is a continuum of care that requires people to first learn their HIV status, then get linked to outpatient HIV care, then initiate antiretroviral therapy, and finally be retained in care and adhere to antiretroviral therapy (Gardner, 2009;Giordano, 2011;Osterberg, 2005;Stone, 2001;Tripathi, 2011). Unfortunately, it has been shown that most PLWH do not progress along this continuum and thus do not have optimal clinical outcomes (Gardner, 2009;Tripathi, 2011). Furthermore, certain populations of PLWH, such as crack users, face additional barriers that limit healthcare access and increase the risk for poor health outcomes (Brewer et al, 2007).…”