title: Time to linkage to care and viro-immunologic parameters of individuals diagnosed before and after the 2006 HIV testing recommendations.
abstract: OBJECTIVE
  To assess the time from linkage to care and viro-immunologic parameters before and after implementation of the Centers for Disease Control and Prevention's 2006 revised human immunodeficiency virus (HIV) testing strategy.
  
  
  METHODS
  Case reports from South Carolina's enhanced HIV/AIDS (acquired immunodeficiency syndrome) Reporting System were used to compare time to linkage to care and viro-immunologic indicators at diagnosis and 1 year after diagnosis of HIV in individuals diagnosed between 2004 and 2006 (n = 2456) with those diagnosed between 2008 and 2010 (n = 2118). CD4 T-cell count/percent and viral load tests were used as a proxy for a clinical visit and to determine disease stage.
  
  
  RESULTS
  Individuals diagnosed between 2008 and 2010 were less likely than those diagnosed between 2004 and 2006 to be in care after 12 months than within 3 months of HIV diagnosis (adjusted odds ratio [AOR] 0.42, 95% confidence interval [CI] 0.34-0.51). Individuals diagnosed between 2008 and 2010 were more likely than those diagnosed between 2004 and 2006 to have high CD4 T-cell counts (>500 cells per cubic millimeter than ≤200 cells per cubic millimeter; AOR 1.24, 95% CI 1.01-1.51) and have undetectable viral loads 1 year post-HIV diagnosis (AOR 8.42, 95% CI 6.96-10.18). Although period of diagnosis did not predict disease stage 1 year post-HIV diagnosis (AOR 0.99, 95% CI 0.87-1.13), there was a decrease from 13% between 2004 and 2006 to 10% between 2008 and 2010 in the percentage of HIV-only patients at diagnosis who progressed to AIDS 1 year post-HIV diagnosis.
  
  
  CONCLUSIONS
  Implementation of routine, opt-out HIV testing resulted in more timely linkage to care and improved viro-immunologic parameters 1 year postdiagnosis when compared with the previous testing recommendations.
authors.affiliation: Arnold School of Public Health, University of South Carolina, Columbia, USA.
authors.forename: Dumbiri J
authors.initials: DJ
authors.lastname: Onyeajam
authors.forename: Ransome
authors.initials: R
authors.lastname: Eke
authors.forename: Terri G
authors.initials: TG
authors.lastname: Stephens
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Duffus
mesh_terms: D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D002487:Centers for Disease Control and Prevention, U.S.; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D013022:South Carolina / Q000453:epidemiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D019562:Viral Load