Abstract
BackgroundLinkage to care after HIV diagnosis is associated with both clinical and public health benefits. However, ensuring and monitoring linkage to care by public health departments has proved to be a difficult task. Here, we report the usefulness of routine monitoring of CD4 T cell counts and plasma HIV viral load as measures of entry into care after HIV diagnosis.MethodsSince July 1, 2006, the San Francisco Department of Public Health (SFDPH) incorporated monitoring initial primary care visit into standard HIV public health investigation for newly diagnosed HIV-infected patients in select clinics. Entry into care was defined as having at least one visit to a primary HIV care provider after the initial diagnosis of HIV infection. Investigators collected reports from patients, medical providers, laboratories and reviewed medical records to determine the date of the initial health care visit after HIV diagnosis. We identified factors associated with increased likelihood of entering care after HIV diagnosis.ResultsOne -hundred and sixty new HIV-infected cases were diagnosed between July 1, 2006 and June 30, 2007. Routine surveillance methods found that 101 of those cases entered HIV medical care and monitoring of CD4 T cell counts and plasma HIV viral load confirmed entry to care of 25 more cases, representing a 25% increase over routine data collection methods. We found that being interviewed by a public health investigator was associated with higher odds of entry into care after HIV diagnosis (OR 18.86 [1.83–194.80], p = .001) compared to cases not interviewed. Also, HIV diagnosis at the San Francisco county hospital versus diagnosis at the county municipal STD clinic was associated with higher odds of entry into care (OR 101.71 [5.29–1952.05], p < .001).ConclusionThe time from HIV diagnosis to initial CD4 T cell count, CD4 T cell value and HIV viral load testing may be appropriate surveillance measures for evaluating entry into care, as well as performance outcomes for local public health departments' HIV testing programs. Case investigation performed by the public health department or case management by clinic staff was associated with increased and shorter time to entry into HIV medical care.
Highlights
Linkage to care after HIV diagnosis is associated with both clinical and public health benefits
In this report we describe the characteristics of patients having a newly diagnosed HIV infection between July 1, 2006 and June 30, 2007 who entered into HIV medical care
Public health investigation and referral to HIV medical care As part of its routine public health activities, the San Francisco Department of Public Health performed HIV public health investigation, including interview and referral to HIV medical care in all patients newly diagnosed with HIV infection at the San Francisco's municipal sexually transmitted diseases (STDs) clinic, the San Francisco county hospital, and 13 community-based primary care clinics affiliated with the county public health care system
Summary
Linkage to care after HIV diagnosis is associated with both clinical and public health benefits. At the public health level, collecting initial CD4 T cell counts and plasma HIV viral loads can determine the stage of HIV infection at diagnosis and serve as a measure of entry into medical care. Several studies have used CD4 T cell count tests or plasma HIV viral load results as markers of care, those studies have not used provider or laboratory-reported test results as surveillance measures to assess entry to HIV medical care in the public health setting [2,5,6]. Surveillance of laboratory reports of CD4 T cell counts and plasma HIV viral loads could be used by public health departments as valid surrogates for entry into HIV medical care after diagnosis, allowing the design, evaluation, and improvement of HIV testing and linkage to care programs. Few local public health departments are using CD4 T cell count data collected for these purposes and many states have not yet established mandatory laboratory reporting of CD4 T cell counts and plasma HIV viral loads
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