title: Foreign-born status as a predictor of engagement in HIV care in a large US metropolitan health system.
abstract: We sought to determine the linkage to and retention in HIV care after HIV diagnosis in foreign-born compared with US-born individuals. From a clinical data registry, we identified 619 patients aged ≥18 years with a new HIV diagnosis between 2000 and 2012. Timely linkage to care was the proportion of patients with an ICD-9 code for HIV infection (V08 or 042) associated with a primary care or infectious disease physician within 90 days of the index positive HIV test. Retention in HIV care was the presence of an HIV primary care visit in each 6-month period of the 24-month measurement period from the index HIV test. We used Cox regression analysis with adjustment for hypothesized confounders (age, gender, race/ethnicity, substance abuse, year, and location of HIV diagnosis). Foreign-born individuals comprised 36% (225/619) of the cohort. Index CD4 count was 225/µl (IQR 67-439/µl) in foreign-born compared with 328/µl (IQR 121-527/µl) in US-born individuals (p < .001). The proportion linked to care was 87% (196/225) in foreign-born compared with 77% (302/394) in US-born individuals (p = .002). The adjusted hazard ratio of linkage to HIV care in foreign-born compared with US-born individuals was 1.28 (95% confidence interval [CI], 1.05-1.56). Once linked, there was no difference in retention in care or virologic suppression at 24 months. These results show that despite late presentation to HIV care, foreign-born persons can subsequently engage in HIV care as well as US-born persons. Interventions that promote HIV screening in foreign-born persons are a promising way to improve outcomes in these populations.
authors.affiliation: a Division of General Internal Medicine , Massachusetts General Hospital , Boston , MA , USA.|b Harvard Medical School , Boston , MA , USA.
authors.forename: Julie H
authors.initials: JH
authors.lastname: Levison
authors.affiliation: a Division of General Internal Medicine , Massachusetts General Hospital , Boston , MA , USA.|b Harvard Medical School , Boston , MA , USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Regan
authors.affiliation: a Division of General Internal Medicine , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: Iman
authors.initials: I
authors.lastname: Khan
authors.affiliation: a Division of General Internal Medicine , Massachusetts General Hospital , Boston , MA , USA.|b Harvard Medical School , Boston , MA , USA.|c Division of Infectious Diseases and the Medical Practice Evaluation Center , Massachusetts General Hospital , Boston , MA , USA.|d Harvard University Center for AIDS Research , Harvard University , Boston , MA , USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012042:Registries; D000072230:Sustained Virologic Response; D014481:United States / Q000208:ethnology; D019037:Urban Health Services / Q000706:statistics & numerical data*
keywords: HIV/AIDS; Immigrant health; engagement in care; foreign born; linkage to care; outcomes