With HIV, Location Matters

After a diagnosis of HIV, linkage to care is crucial for achieving viral suppression. The US National HIV/AIDS Strategy (NHAS) recommends immediate linkage to care after HIV diagnosis.¹ However factors associated with linkage to care are not well understood.

A new study published in Journal of Acquired Immune Deficiency Syndromes² evaluated patient data collected through the City of Philadelphia’s Enhanced HIV/AIDS Reporting System (eHARS) to understand the factors associated with linkage to HIV care. The investigators examined 1359 adults with newly diagnosed HIV infection in Philadelphia between 2010 and 2011 and determined whether diagnosis setting (medical clinic, inpatient setting, counseling and testing center, correctional facility) affected time to linkage to care.² The time to linkage to care was calculated as the time difference between date of diagnosis and first CD4/viral load.

The study found that 1093 patients (80%) linked to care but that there were marked differences according to the site of diagnosis.

After adjusting for other confounding factors, HIV diagnosis in inpatient settings, counseling and testing centers, and correctional facilities was associated with 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 with medical clinics, respectively. Notably, only 60% of the sample linked to care within 3 months of HIV diagnosis.²

Primary care physicians who care for HIV-infected patients would do well to be aware of the importance of the diagnosis site on subsequent linkage to HIV care-especially if the diagnosis site is without co-located medical care.²

References:

1. Yehia B, Frank I. Battling AIDS in America: an evaluation of the national HIV/AIDS strategy. Am J Public Health. 2011;101:e4-8

2. Yehia BR, Ketner E, Momplaisir F, et al. Location of HIV diagnosis impacts linkage to medical care.J Acquir Immune Defic Syndr. 2014 Dec 2; [Epub ahead of print].