title: Poor Linkage to Care Despite Significant Improvement in Access to Early cART in Central Poland - Data from Test and Keep in Care (TAK) Project.
abstract: BACKGROUND
  The main objective of the TAK project is investigating barriers in accessing HIV care after HIV-diagnosis at the CBVCTs of central Poland. Here we describe factors associated with and changes over time in linkage to care and access to cART.
  
  
  METHODS
  Data collected in 2010-2013 in CBVCTs were linked with HIV clinics records using unique identifiers. Individuals were followed from the day of CBVCTs visit until first clinical visit or 4/06/2014. Cox-proportional hazard models were used to identify factors associated with being linked to care and starting cART.
  
  
  RESULTS
  In total 232 persons were diagnosed HIV-positive and 144 (62.1% 95%CI: 55.5-68.3) persons were linked to care. There was no change over time in linkage to care (p = 0.48), while time to starting cART decreased (p = 0.02). Multivariate factors associated with a lower rate of linkage to care were hetero/bisexual sexual orientation, lower education, not having an HIV-positive partner and not using condoms in a stable relationship. Multivariate factors associated with starting cART were lower education, recent year of linked to care, and first HIV RNA and CD4 cell count.
  
  
  CONCLUSIONS
  Benefits of linkage to care, measured by access to early treatment, steadily improved in recent years. However at least 1 in 3 persons aware of their HIV status in central Poland remained outside professional healthcare. Persons at higher risk of remaining outside care, thus target population for future interventions, are bi/heterosexuals and those with lower levels of education.
authors.affiliation: Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland.|Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland.
authors.forename: Justyna D
authors.initials: JD
authors.lastname: Kowalska
authors.affiliation: Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Leah
authors.initials: L
authors.lastname: Shepherd
authors.affiliation: Foundation of Social Education (FES), Warsaw, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Ankiersztejn-Bartczak
authors.affiliation: Medical University of Warsaw, Department of Infectious and Tropical Diseases and Hepatology, Warsaw, Poland.
authors.forename: Aneta
authors.initials: A
authors.lastname: Cybula
authors.affiliation: Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Czeszko-Paprocka
authors.affiliation: Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Firląg-Burkacka
authors.affiliation: Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.affiliation: Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland.|Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Horban
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011044:Poland; D016016:Proportional Hazards Models
chemical_list: D019380:Anti-HIV Agents