Discrepant Measures of HIV Linkage Rates: HIV Surveillance Versus Medical Record Data New York City (NYC) Health Department Sexually Transmitted Disease (STD) Clinics, 2014

Background:  NYC mandates reporting of HIV viral load/CD4 counts in order to monitor the continuum of HIV care. NYC Health Department STD clinics identify 10% of NYC’s new HIV diagnoses annually, and provide linkage to HIV follow-up care. STD patient records (STD*EMR) indicate 82% (244/298) of newly-diagnosed HIV patients in 2014 were linked to HIV care within 90 days of diagnosis. NYC HIV Surveillance indicated a linkage rate of 69% (205/298).

Methods:  NYC STD clinics define successful linkage as confirmed attendance at an HIV medical care facility within 90 days of diagnosis. For HIV Surveillance purposes timely linkage is determined by an HIV viral load/CD4 test ordered by a NYC facility 8-91 days after diagnosis. We evaluated discrepancies in linkages documented in STD*EMR but not in the NYC HIV surveillance registry, via STD*EMR review and contact with HIV referral providers. 

Results:  HIV Surveillance data indicate that 31% (93/298) of newly diagnosed HIV cases in STD clinics did not receive timely linkage. Of the 93, 53% (49/93) appear successfully linked in STD*EMR, however; 27% (13/49) had no record of referral/attendance at the selected referral facility; 22% (11/49) attended appointments at referral facilities but did not complete required labs; 20% (10/49) linked after 90 days; 16% (8/49) were linked and completed labs 0-7 days after diagnosis; 10% (5/49) received care outside NYC; 2% (1/49) provided different identifying information to the referral facility; and for 2% (1/49), additional testing did not confirm HIV-infection.

Conclusions:  We identified opportunities to improve HIV linkage, including: ensuring that referral appointments are scheduled/documented at both STD clinics and referral facilities, reinforcing the importance of timely linkage with BSTD staff, and requiring that staff collect information on viral load/CD4 testing during follow-up with referral providers. Linkage rates must be improved to ensure better health outcomes for HIV-positive individuals and their partners.