Factors Associated With No or Delayed Linkage to Care in Newly Diagnosed Human Immunodeficiency Virus (HIV)-1-Infected Patients Identified by Emergency Department-based Rapid HIV Screening Programs in Two Urban EDs Academic Emergency Medicine, 05/21/2012

Rothman RE et al. – In spite of dedicated resources for arranging linkage to care (LTC) in the emergency department (ED) HIV testing programs, nearly 50% of patients did not have successful LTC (i.e., LTC occurred at >30 days), although >80% of patients were LTC within 1 year of initial diagnosis.

• This was a retrospective analysis of programmatic data from two established urban ED rapid HIV screening programs between November 2005 and October 2009.
• Trained HIV program assistants interviewed all patients tested to gather risk behavior data using a structured data collection instrument.
• Reactive results were confirmed by Western blot testing. Patients were provided with scheduled appointments at HIV specialty clinics at the institutions where they tested positive within 30days of their ED visit.
• “Successful” LTC was defined as attendance at the HIV outpatient clinic within 30days after HIV diagnosis, in accordance with the ED National HIV Testing Consortium metric.
• “Any” LTC was defined as attendance at the outpatient HIV clinic within 1year of initial HIV diagnosis.
• Multivariate logistic regression was performed to determine factors associated with any LTC or successful LTC.

• Of the 15,640 tests administered, 108 (0.7%) were newly identified HIV–positive cases.
• Nearly half (47.2%) of the patients had been previously tested for HIV.
• Successful LTC occurred in 54% of cases; any LTC occurred in 83% of cases.
• In multivariate analysis, having public medical insurance and being self–pay were negatively associated with successful LTC (odds ratio [OR]=0.33, 95% confidence interval [CI]=0.12 to 0.96; OR=0.34, 95% CI=0.13 to 0.89, respectively); being female and having previously tested for HIV was negatively associated with any LTC (OR=0.30, 95% CI=0.10 to 0.93; OR=0.23, 95% CI=0.07 to 0.77, respectively).