Trends and predictors of linkage to HIV outpatient care following diagnosis in the era of expanded testing in England, Wales and Northern Ireland: Results of a national cohort study

S. Croxford, F. Burns, A. Copas, Z. Yin, Valerie Delpech

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: We explore trends in linkage to HIV care following diagnosis and investigate the impact of diagnosis setting on linkage in the era of expanded testing. Methods: All adults (aged ≥ 15 years) diagnosed with HIV between 2005 and 2014 in England, Wales and Northern Ireland (EW&NI) were followed up until the end of 2017. People who died within 1 month of diagnosis were excluded (n = 1009). Trends in linkage to outpatient care (time to first CD4 count) were examined by sub-population and diagnosis setting. Logistic regression identified predictors of delayed linkage of > 1 month, > 3 months and > 1 year post-diagnosis (2012–2014). Results: Overall, 97% (60 250/62 079) of people linked to care; linkage ≤ 1 month was 75% (44 291/59 312), ≤ 3 months was 88% (52 460) and ≤ 1 year was 95% (56 319). Median time to link declined from 15 days [interquartile range (IQR): 4–43] in 2005 to 6 (IQR: 0–20) days in 2014 (similar across sub-populations/diagnosis settings). In multivariable analysis, delayed linkage to care was associated with acquiring HIV through injecting drug use, heterosexual contact or other routes compared with sex between men (> 1 month/3 months/1 year), being diagnosed in earlier years (> 1 month/3 months/1 year) and having a first CD4 ≥ 200 cells/μL (> 3 months/1 year). Diagnosis outside of sexual health clinics, antenatal services and infectious disease units predicted delays of > 1 month. By 3 months, only diagnosis in ‘other’ settings (prisons, drug services, community and other medical settings) was significant. Conclusions: Linkage to care following HIV diagnosis is relatively timely in EW&NI. However, non-traditional testing venues should have well-defined referral pathways established to facilitate access to care and treatment.

Original languageEnglish
Pages (from-to)491-501
Number of pages11
JournalHIV Medicine
Volume22
Issue number6
Early online date2 Feb 2021
DOIs
Publication statusE-pub ahead of print - 2 Feb 2021

Keywords

  • HIV infection/diagnosis
  • HIV infection/epidemiology
  • United Kingdom
  • adults
  • patient care
  • epidemiology
  • diagnosis
  • HIV infection

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