Predictors of Linkage to Care for Newly Diagnosed HIV-Positive Adults.
BACKGROUND
Linkage to care following a human immunodeficiency virus (HIV) diagnosis is critical. In the U.S. only 69% of patients are successfully linked to care, which results in delayed receipt of antiretroviral therapy leading to immune system dysfunction and risk of transmission to others.


METHODS
We evaluated predictors of failure to link to care at a large urban healthcare center in Philadelphia in order to identify potential intervention targets. We conducted a cohort study between May 2007 and November 2011 at hospital-affiliated outpatient clinics, emergency departments (EDs), and inpatient units.


RESULTS
Of 87 patients with a new HIV diagnosis, 63 (72%) were linked to care: 23 (96%) from the outpatient setting and 40 (63%) from the hospital setting (ED or inpatient) (p<0.01). Those who were tested in the hospital-based settings were more likely to be black (p=0.01), homeless (p=0.03), and use alcohol or drugs (p=0.03) than those tested in the outpatient clinics. Patients tested in the ED or inpatient units had a 10.9 fold (p=0.03) higher odds of failure to link compared to those diagnosed in an outpatient clinic. When testing site was controlled, unemployment (OR 12.2;p<0.01) and substance use (OR 6.4;p<0.01) were associated with failure to link.


CONCLUSIONS
Our findings demonstrate the comparative success of linkage to care in outpatient medical clinics versus hospital-based settings. This study both reinforces the importance of routine opt-out HIV testing in outpatient practices, and demonstrates the need to better understand barriers to linkage.
Drexel University College of Medicine, Division of Infectious Diseases and HIV Medicine, Philadelphia, Pennsylvania.
Erika
E
Aaron
George Washington University School of Medicine and Health Sciences, Washington, DC.
Tyler
T
Alvare
Drexel University School of Public Health, Epidemiology and Biostatistics, Philadelphia, Pennsylvania.
Ed J
EJ
Gracely
Drexel University College of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania.
Ralph
R
Riviello
Drexel University College of Medicine, Division of Infectious Diseases and HIV Medicine, Philadelphia, Pennsylvania.
Amy
A
Althoff
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010358:Patient Participation; D015143:Philadelphia; D055815:Young Adult