Abstract
BackgroundThe main objective of the TAK project is investigating barriers in accessing HIV care after HIV-diagnosis at the CBVCTs of central Poland. Here we describe factors associated with and changes over time in linkage to care and access to cART.MethodData collected in 2010–2013 in CBVCTs were linked with HIV clinics records using unique identifiers. Individuals were followed from the day of CBVCTs visit until first clinical visit or 4/06/2014. Cox-proportional hazard models were used to identify factors associated with being linked to care and starting cART.ResultsIn total 232 persons were diagnosed HIV-positive and 144 (62.1% 95%CI: 55.5–68.3) persons were linked to care. There was no change over time in linkage to care (p = 0.48), while time to starting cART decreased (p = 0.02). Multivariate factors associated with a lower rate of linkage to care were hetero/bisexual sexual orientation, lower education, not having an HIV-positive partner and not using condoms in a stable relationship. Multivariate factors associated with starting cART were lower education, recent year of linked to care, and first HIV RNA and CD4 cell count.ConclusionsBenefits of linkage to care, measured by access to early treatment, steadily improved in recent years. However at least 1 in 3 persons aware of their HIV status in central Poland remained outside professional healthcare. Persons at higher risk of remaining outside care, thus target population for future interventions, are bi/heterosexuals and those with lower levels of education.
Highlights
It is estimated that up to 50% of HIV positive persons in Europe are unaware of their HIV infection and half of those newly diagnosed present late for care in Central and Eastern Europe [1,2,3]
There was no change over time in linkage to care (p = 0.48), while time to starting combination antiretroviral therapy (cART) decreased (p = 0.02)
Multivariate factors associated with starting cART were lower education, recent year of linked to care, and first HIV RNA and CD4 cell count
Summary
It is estimated that up to 50% of HIV positive persons in Europe are unaware of their HIV infection and half of those newly diagnosed present late for care in Central and Eastern Europe [1,2,3]. WHO and ECDC both recommend decentralization and diversification of HIV testing systems at both local and national levels [9]. This presents new challenges for linkage and engagement in HIV care, but there are few guidelines addressing this point [10]. The main objective of the TAK project is investigating barriers in accessing HIV care after HIV-diagnosis at the CBVCTs of central Poland. We describe factors associated with and changes over time in linkage to care and access to cART
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