title: The Perilous Road from HIV Diagnosis in the Hospital to Viral Suppression in the Outpatient Clinic.
abstract: The HIV care continuum has received considerable attention in recent years, however, few care continua focus on the population of patients who are diagnosed during an inpatient hospital admission. We aimed to describe the HIV care continuum for patients newly diagnosed during hospitalization through 24-month follow-up. A retrospective chart review of HIV patients diagnosed at Grady Memorial Hospital from 2011 to 2012 was performed and records were matched to Georgia Department of Public Health HIV/AIDS surveillance data. Descriptive statistics and statistical tests of independence were utilized. Ninety-four new diagnoses were confirmed during the 2-year study period. Median age was 43 years (interquartile range [IQR] 30-51), 77% were male, 72% were non-Hispanic Black, 31% were men who have sex with men (MSM), and 77% were uninsured. Median CD4 count at diagnosis was 134 cells/μL (IQR 30-307). Eighty-four percent received their diagnosis before hospital discharge, 68% linked to care by 90 days, 73% were retained for 12 months, 48% were virologically suppressed by 12 months, 58% were retained for 24 continuous months, and 38% achieved continuous viral suppression (VS) during the initial 24 months after diagnosis. Late diagnosis is a persistent problem in hospitalized patients. Despite relative success with linkage to care and 12-month retention in care, a minority of patients maintained retention and VS for 24 continuous months.
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia .|2 Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia .|3 Infectious Diseases Program , Grady Health System, Atlanta, Georgia .
authors.forename: Jonathan
authors.initials: J
authors.lastname: Colasanti
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia .|4 Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, Georgia .
authors.forename: Neela D
authors.initials: ND
authors.lastname: Goswami
authors.affiliation: 5 Emory University School of Medicine , Atlanta, Georgia .
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Khoubian
authors.affiliation: 6 HIV/AIDS Epidemiology Section , Georgia Department of Public Health, Atlanta, Georgia .
authors.forename: Eugene
authors.initials: E
authors.lastname: Pennisi
authors.affiliation: 2 Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia .
authors.forename: Christin
authors.initials: C
authors.lastname: Root
authors.affiliation: 3 Infectious Diseases Program , Grady Health System, Atlanta, Georgia .|7 Department of Social Work, Grady Health System , Atlanta, Georgia .
authors.forename: Dorothy
authors.initials: D
authors.lastname: Ziemer
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia .|3 Infectious Diseases Program , Grady Health System, Atlanta, Georgia .|8 Center for AIDS Research, Emory University , Atlanta, Georgia .
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Armstrong
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia .|2 Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia .|8 Center for AIDS Research, Emory University , Atlanta, Georgia .
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Rio
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000639:trends*; D057210:Delayed Diagnosis; D005260:Female; D005845:Georgia; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000821:virology; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D062486:Public Health Surveillance; D012189:Retrospective Studies; D019562:Viral Load / Q000706:statistics & numerical data
chemical_list: D019380:Anti-HIV Agents