Location of HIV Diagnosis Impacts Linkage to Medical Care

Abstract

We evaluated 1,359 adults newly diagnosed with HIV in Philadelphia in 2010-2011 to determine if diagnosis site (medical clinic, inpatient setting, counseling and testing center (CTC), correctional facility) impacted time to linkage to care (difference between date of diagnosis and first CD4/viral load). 1,093 patients (80%) linked to care: 86% diagnosed in medical clinics, 75% in inpatient settings, 62% in CTCs, and 44% in correctional facilities. Adjusting for other factors, diagnosis in inpatient settings, CTCs, and correctional facilities resulted in a 33% (adjusted hazard ratio=0.77, 95% confidence interval=0.64-0.92), 46% (0.56, 0.42-0.72), and 75% (0.25, 0.18-0.35) decrease in the probability of linkage compared to medical clinics, respectively.

The Perilous Road from HIV Diagnosis in the Hospital to Viral Suppression in the Outpatient Clinic

“…9 The closest HIV clinic (IDP) for uninsured Atlanta metro area residents with a CD4 count <200 cells/lL is less than 2 miles from the hospital. The Fulton County Health Department, where uninsured patients with a CD4 count >200 cells/lL are generally referred for care, is located directly across the street from GMH.…”

“…9 HIV diagnosis and timely linkage to care remain a critical aspect of the test-andtreat approach for HIV prevention, yet successful linkage to care is not sufficient for effective broad-scale treatment as prevention. 10,11 At Grady Health System (GHS), we are uniquely situated to describe a full care continuum for patients who are newly diagnosed in the hospital.…”

Retention in Care and Medication Adherence: Current Challenges to Antiretroviral Therapy Success

“…These include transitions from correctional institutions to community-based care, inpatient to outpatient care, and pediatric/adolescent to adult clinics. A study evaluating 1,359 newly diagnosed HIV-infected patients found that, compared to medical clinics, diagnosis at correctional facilities, counseling and testing centers, and inpatient settings resulted in a 75%, 46%, and 33% decrease in the probability of linkage, respectively [45]. In a retrospective cohort study of 2,215 HIV-infected patients who were receiving ART at a Texas prison, only 30% filled their first ART prescription within 60 days after their release [46].…”

HIV-Yield and Linkage in 13 Military Health Facilities in Cameroon: a Retrospective Study

“…HIV status disclosure to family/relatives was significantly associated with linkage to care (AHR=2.64; 95% CI 2.05 to 3.39). In this same option, a study carried out by Yhia et al [12] in the USA (Philadelphia), demonstrated that diagnosis in inpatient settings, counseling and testing centers, and correctional facilities resulted in a 23% (AHR 0.77, 95% confidence interval 0.64-0.92), 46% (0.56, 0.42-0.72), and 75% (0.25, 0.18-0.35) decrease in the hazard of linkage to care compared to diagnosis in medical care clinics, respectively. Additionally, the hazard of not linking to care was greater for black patients (vs. white), persons with IDU as their HIV risk factor (vs. heterosexual), and those diagnosed in 2010 (vs. 2011).…”