Assessment of Linkage to Care and the Disease Stage at Diagnosis for South Carolina HIV-infected Individuals Diagnosed from January 1st, 2004 to December 31st, 2006

Background:
Early identification of infected patients and early entry into care are pivotal to slowing the spread of the HIV epidemic.

Objective:
To assess disease stage at HIV diagnosis and to determine the predictors of late entry into HIV medical care.

Method:
Cohort study of individuals newly diagnosed from 1/1/04 to 12/31/06 who were reported to the HIV/AIDS Reporting System (HARS). Reporting of all HIV laboratory markers is mandatory by SC law. The first CD4 count was used to stage disease at diagnosis and the second CD4 count or viral load test was used as a surrogate for entry into care (dichotomized at 60 days and 90 days from diagnosis). Logistic regression models were used to adjust for predictors of entry into care.

Result:
Of the 2362 newly diagnosed individuals, 2129 (90%) individuals had laboratory markers reported. The median initial CD4 cell count was 304 cells/mm³, 735/2129 (35%) had a CD4 count ≤200 cells/mm³, 1194/2129 (56%) had a CD4 count ≤350 cells/mm³, and for 549/1894 (29%) the viral load was ≥100,000 copies/mL. Forty-seven percent received an AIDS diagnosis within one year of initial HIV test.
Only 26% and 38% of individuals newly diagnosed were linked to care within 60 days and 90 days, respectively. Linkage to care after 60 days was significantly associated with age 40-49 years (adjusted odds ratio [aOR]=0.72; 95% confidence interval [95%CI]=0.52, 0.98), injection drug use (aOR=0.56; 95%CI=0.34, 0.94), hospital patients (aOR=0.61; 95%CI=0.44, 0.83) and state facilities (aOR=0.04; 95%CI=0.03, 0.07). Linkage to care after 90 days was significantly associated with black race (aOR=1.30; 95%CI=1.05, 1.61), county health department (aOR=1.60; 95%CI=1.25, 2.06) and state facilities (aOR=0.23; 95%CI=0.16, 0.33).

Conclusion:
In SC, late diagnosis of HIV and late entry into care persist as challenges to HIV prevention.

Implications:
Enhanced screening efforts to detect HIV infection sooner should include methods aimed at improving linkage to care.