Factors associated with delayed entry into primary HIV medical care after HIV diagnosis

Background: Many patients newly diagnosed with HIV delay accessing primary HIV medical care for far longer than the 3 month standard recommended by the CDC. Since prompt entry into care improves patient outcomes, the elucidation of the factors that delay this linkage are essential.

Methods: We conducted a retrospective cohort study of 1,266 individuals newly diagnosed with HIV in Philadelphia between July 1, 2005 and June 30, 2006 to determine the median time in months between diagnosis and entry into care and to assess the individual, diagnosing facility, and community level factors associated with delayed linkage.

Results: The median time to entry into care for all subjects was 8 months, with a range of 1 to 26 months. Factors associated with delayed entry into care included age > 40 years (hazard ratio (HR), 0.85; 95% confidence interval [CI], 0.75-0.97) and diagnosis as an inpatient in the hospital (HR, 0.37; 95%CI, 0.37-0.57). Factors associated with earlier entry into care included Hispanic ethnicity (HR, 1.39; 95% CI, 1.05-1.84), MSM as HIV transmission risk factor (HR 1.27; 95% CI, 1.03-1.56), and residence in a census tract with a high poverty rate (HR 1.68; 95% CI, 1.22-2.30).

Discussion: Individuals newly diagnosed with HIV in Philadelphia present to care far later than the 3 month standard recommended by the CDC. This highlights the tremendous need for interventions to improve linkage to care for all individuals newly diagnosed with HIV, especially those > 40 years of age and those diagnosed as inpatients in the hospital.