title: Factors responsible for incomplete linkage to care after HIV diagnosis: preliminary results from the Test and Keep in Care (TAK) project.
abstract: OBJECTIVE
  Linkage to care after HIV diagnosis remains underinvestigated in Europe, yet delays in linkage to care are an important obstacle to controlling the HIV epidemic. The Test and Keep in Care (TAK) project aims to determine the prevalence of HIV-positive persons who are lost or late to care and factors associated with this.
  
  
  METHODS
  Data from community-based voluntary counselling and testing that occurred in 2010-2011 were linked with data from HIV clinics using unique test numbers. Persons not registered in HIV clinics were considered lost to care (LTC). For statistical analysis, nonparametric tests were used for comparison, and a multivariable logistic regression model was developed that included all variables with P<0.1 from the univariable models.
  
  
  RESULTS
  A total of 110 persons were diagnosed as HIV-positive: 91% lived in central Poland, 5% were female and 71% were men who have sex with men (MSM). Forty-seven (42%) persons were LTC, seven of whom did not collect their enzyme-linked immunosorbent assay (ELISA) test result. Of those who registered, 75% registered within 1 month from HIV diagnosis, and 54% were late presenters. LTC individuals were more likely to have heterosexual or bisexual orientation, to have >20 sexual partners, to not be in a relationship with an HIV-positive partner, to not use condoms, and to be taking their first HIV test. In a logistic regression model, after adjusting for these factors, using condoms in a stable relationship decreased the odds of LTC by 72% (odds ratio 0.28; confidence interval 0.11-0.67).
  
  
  CONCLUSIONS
  Integration into care after HIV diagnosis requires improvement. Our results suggest that broadening awareness and counselling about sexual risks may have a positive impact.
authors.affiliation: Foundation of Social Education, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Ankiersztejn-Bartczak
authors.forename: E
authors.initials: E
authors.lastname: Firląg-Burkacka
authors.forename: H
authors.initials: H
authors.lastname: Czeszko-Paprocka
authors.forename: J
authors.initials: J
authors.lastname: Kubicka
authors.forename: A
authors.initials: A
authors.lastname: Cybula
authors.forename: A
authors.initials: A
authors.lastname: Horban
authors.forename: J D
authors.initials: JD
authors.lastname: Kowalska
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D017280:Condoms / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D012017:Referral and Consultation; D012042:Registries; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology*; D013997:Time Factors; D044465:White People
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; late presenter; linkage; voluntary counselling and testing