Factors of Successful Linkage and Retention to HIV Care in a National HIV Testing and Linkage Program

Background: Understanding which factors inherent to clients or service settings are predictive of successful linkage and retention can lead to better outcomes along the HIV care continuum. 

Methods: We extracted HIV testing and clinical data from a major HIV/AIDS service organization’s electronic medical record system for clients testing positive at the organization, and for clients referred from other agencies for linkage into care. Cases (n=8,521) from October 2008 through January 2015 were included in the analysis. We assessed linkage, retention, antiretroviral prescriptions, and viral suppression based on CDC definitions and conducted a logistic regression to identify factors predictive of successful linkage and retention.

Results:  A majority (77.1%) of clients were linked into care within 90 days of testing HIV positive; 61.9% were prescribed antiretrovirals, 54.3% were retained in care, and 41.0% reached viral suppression. The odds of linking among older age groups were 2 or more times (OR 2.00 to 2.80; p<.01) that of clients age 20 or younger; the odds of Hispanics linking were less (OR: 0.61, 95% CI: 0.42 – 0.89) compared to Whites; the odds of linking clients that tested at a fixed storefront were 1.48 times (95% CI: 1.03 – 2.12) and the odds of linking referred clients were 4.23 times (95% CI: 2.99 – 5.97) compared to clients testing at a clinic site. The odds of retaining homeless clients were less (OR: 0.37, 95% CI: 0.19 – 0.72) compared to non-homeless clients; the odds of retaining clients with a new diagnosis were 6.58 times (95% CI: 3.25 – 13.30) compared to clients previously diagnosed.

Conclusions: While a majority of clients were linked and retained into care, areas for improvement remain. We are increasing linkage efforts for younger and Hispanic clients, and those using mobile testing and increasing retention efforts for homeless clients and those with an existing HIV diagnosis.