Evaluating Linkage to Care for Individuals with Newly Diagnosed HIV in the Philadelphia Dept. of Public Health STD Clinic

Background: Linkage to care is a crucial aspect of the HIV treatment cascade. Setting of HIV diagnosis is associated with variation in linkage to care rates with medical sites having the highest rates and jails having the lowest.  In Philadelphia, the health department STD clinic refers individuals with positive HIV results to care. However, the STD clinic does not provide ongoing HIV-specific care on site, thus there could be failures in linkage to care. 

Methods:  Philadelphia residents newly diagnosed with HIV from 2009 to 2012 at the PDPH STD clinic were compared to Philadelphia residents newly diagnosed in all other settings. Demographics and linkage to care were compared between the two groups. Linkage to care is defined as having at least 1 viral load or CD4 test at least 90 within HIV diagnosis

Results:  From 2009 to 2012, 239 Philadelphia residents were newly diagnosed with HIV in the STD clinic and 2,828 residents were newly diagnosed in all other settings. HIV cases diagnosed in the STD clinic were slightly younger, more male (90%), and more likely men who have sex with men (MSM) (67%) than the non-clinic group .Linkage to care for STD clinic patients was significantly lower than that of other sites (59% vs. 70%, p<0.0003). Linkage to care improved over time with over 85% of patients linked  to care regardless of diagnosis setting since 2012, meeting the goal set by the National HIV/AIDS Strategy.

Conclusions: With 8% of new HIV diagnoses, the STD clinic is a major HIV testing site in Philadelphia.  Improvement in linkage has been seen over time citywide and in the STD clinic. Assuring that HIV infected STD clinic patients are adequately linked to care is a high priority for the clinic. Additional assessments will be conducted to identify opportunities for further improvements.