title: Factors associated with no or delayed linkage to care in newly diagnosed human immunodeficiency virus (HIV)-1-infected patients identified by emergency department-based rapid HIV screening programs in two urban EDs.
abstract: OBJECTIVE
  The objective was to describe the proportions of successful linkage to care (LTC) and identify factors associated with LTC among newly diagnosed human immunodeficiency virus (HIV)-positive patients, from two urban emergency department (ED) rapid HIV screening programs.
  
  
  METHODS
  This was a retrospective analysis of programmatic data from two established urban ED rapid HIV screening programs between November 2005 and October 2009. Trained HIV program assistants interviewed all patients tested to gather risk behavior data using a structured data collection instrument. Reactive results were confirmed by Western blot testing. Patients were provided with scheduled appointments at HIV specialty clinics at the institutions where they tested positive within 30 days of their ED visit. "Successful" LTC was defined as attendance at the HIV outpatient clinic within 30 days after HIV diagnosis, in accordance with the ED National HIV Testing Consortium metric. "Any" LTC was defined as attendance at the outpatient HIV clinic within 1 year of initial HIV diagnosis. Multivariate logistic regression was performed to determine factors associated with any LTC or successful LTC.
  
  
  RESULTS
  Of the 15,640 tests administered, 108 (0.7%) were newly identified HIV-positive cases. Nearly half (47.2%) of the patients had been previously tested for HIV. Successful LTC occurred in 54% of cases; any LTC occurred in 83% of cases. In multivariate analysis, having public medical insurance and being self-pay were negatively associated with successful LTC (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.12 to 0.96; OR = 0.34, 95% CI = 0.13 to 0.89, respectively); being female and having previously tested for HIV was negatively associated with any LTC (OR = 0.30, 95% CI = 0.10 to 0.93; OR = 0.23, 95% CI = 0.07 to 0.77, respectively).
  
  
  CONCLUSIONS
  In spite of dedicated resources for arranging LTC in the ED HIV testing programs, nearly 50% of patients did not have successful LTC (i.e., LTC occurred at >30 days), although >80% of patients were LTC within 1 year of initial diagnosis. Further evaluation of the barriers associated with successful LTC for those with public insurance and self-pay is warranted.
authors.affiliation: Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
authors.forename: Gabor D
authors.initials: GD
authors.lastname: Kelen
authors.forename: Leah
authors.initials: L
authors.lastname: Harvey
authors.forename: Judy B
authors.initials: JB
authors.lastname: Shahan
authors.forename: Heather
authors.initials: H
authors.lastname: Hairston
authors.forename: Avanthi
authors.initials: A
authors.lastname: Burah
authors.forename: Daniel
authors.initials: D
authors.lastname: Moring-Parris
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D003695:Delivery of Health Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000458:organization & administration; D016015:Logistic Models; D008297:Male; D008396:Maryland; D008403:Mass Screening / Q000458:organization & administration*; D017057:Medically Uninsured; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000458:organization & administration* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult