A higher standard of care for the most vulnerable: Examining how behavioral, social, medical, and structural factors influence linkage to care among newly diagnosed HIV positive adults

Background: Despite great strides in development and availability of antiretroviral therapy, over 30% of individuals with HIV do not enter into HIV treatment. Linking newly diagnosed persons continues to remain a challenge. The aim of the study is to investigate the effects of socioeconomic, biomedical, and structural factors on patient's linkage to care after HIV diagnosis and to utilize these findings to devise more successful interventions. Methods: A cross-sectional, retrospective study was conducted using medical records for 94 patients diagnosed between May 2007 and November 2011. All subjects were identified at one major urban emergency department and three medical clinics located in areas of high HIV/AIDs prevalence. Twenty socioeconomic and biomedical indicators were examined in bivariate analysis for association with positive patients receiving treatment. Results: Medical records for 89 patients were determined to be eligible. We found that mental illness (p < 0.04), past behavior in health care environments (p < 0.001), drug abuse (p < 0.001), unemployment (p < 0.01), and homelessness predicted patient failure to link to care. Conclusion: These findings suggest that in order to improve successful linkage to care for newly diagnosed HIV patients, interventions must be adequately broad to address the complex social and structural challenges facing HIV positive populations.