Improving Timely Linkage to Care among Newly Diagnosed HIV-Infected Youth: Results of SMILE

Abstract Background It is estimated that 1,295 per 100,000 are people living with HIV (PLWH) in New Haven, which is the second highest rate of HIV prevalence in Connecticut. Since 2009, New Haven has established the Ryan White (RW) HIV Care Continuum. The main goals of HIV care are early linkage to care, ART initiation, and HIV viral suppression. This study is designed to understand the trends and outcomes in newly diagnosed PLWH in New Haven County. Methods This study is a retrospective medical record review of all newly diagnosed RW eligible PLWH from January 1, 2009 to December 31, 2018. The data were collected in REDCap database and included demographics, HIV risk factor, presence of mental health and/or substance abuse disorder, date of diagnosis, date of initial visit, and ART initiation. Health outcomes such as AIDS at diagnosis and rate of viral suppression were evaluated. The data were then analyzed to show the trends over 10 years. Results From January 1, 2009 to December 31, 2018 there were 420 newly diagnosed RW PLWH. Sixty-seven percent of those were male, 56% were non-white, 47% self-identified as Men who have Sex with Men (MSM), and 41% were heterosexual. Twenty-nine percent had AIDS-defining condition at the time of the diagnosis. Thirty-four percent of the 420 patients had a mental health and/or substance use disorder; 53% of those were MSM and 51% were non-white. Over the 10-year period, it was noted that the duration between date of HIV diagnosis and linkage to care as well as ART initiation decreased. This decline was associated with a substantial increase in viral suppression. The average time between the dates of HIV diagnosis and initial visit decreased from 269 days in 2009 to 13 days in 2018. Moreover, the average time between the dates of diagnosis and ART initiation dropped from 308 days in 2009 to 15 days in 2018. The 1-year HIV viral suppression rate subsequently doubled from 44% in 2009 to 87% in 2018 (P < 0.01). Conclusion The Ryan White HIV Care Continuum Model with emphasis on early linkage to care and ART initiation can have a significant impact on HIV viral suppression at a community level for newly diagnosed patients. Another important observation in this study was the alarming high rate of AIDS at diagnosis, which highlights the need for universal HIV testing, and early diagnosis. Disclosures All authors: No reported disclosures.

Download Full-text

Applying a machine learning modelling framework to predict delayed linkage to care in patients newly diagnosed with HIV in Mecklenburg County, North Carolina, USA

AIDS ◽

10.1097/qad.0000000000002830 ◽

2021 ◽

Vol 35 (Supplement 1) ◽

pp. S29-S38 ◽

Cited By ~ 1

Author(s):

Shi Chen ◽

Yakubu Owolabi ◽

Michael Dulin ◽

Patrick Robinson ◽

Brian Witt ◽

...

Keyword(s):

Machine Learning ◽

North Carolina ◽

Linkage To Care ◽

Newly Diagnosed ◽

Modelling Framework ◽

Mecklenburg County

Download Full-text

Evaluation of a Client-Centered Linkage Intervention for Patients Newly Diagnosed with HIV at an Urban United States LGBT Center: The Linkage to Care Specialist Project

AIDS Patient Care and STDs ◽

10.1089/apc.2017.0057 ◽

2017 ◽

Vol 31 (7) ◽

pp. 283-289 ◽

Cited By ~ 1

Author(s):

Jesse Bendetson ◽

Rhodri Dierst-Davies ◽

Risa Flynn ◽

Matthew R. Beymer ◽

Amy R. Wohl ◽

...

Keyword(s):

United States ◽

Linkage To Care ◽

Newly Diagnosed ◽

Care Specialist

Download Full-text

Patient-level Factors Associated with HIV Suppression at Admission Across a Large Integrated Healthcare System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1062 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S422-S422

Author(s):

Marileys FigueroaSierra ◽

Monica Schmidt ◽

Melanie D Spencer ◽

Michael Leonard

Keyword(s):

Acute Care ◽

Viral Suppression ◽

Age Groups ◽

Linkage To Care ◽

Hiv Care ◽

Median Income ◽

Newly Diagnosed ◽

Black Race ◽

Patient Level ◽

Number Of Patients

Abstract Background Linkage to care is a critical step for achieving HIV viral suppression and improving outcomes in newly diagnosed individuals. An unexpectedly high number of patients who have undiagnosed HIV or ineffective viral suppression are identified upon admission to acute care. This study aims to understand factors that may be associated with lack of viral suppression for patients who are newly diagnosed at admission. Methods Patients with HIV, admitted to one of our eight acute care facilities were identified (n = 1,632) from medical records. Of these, 94 were newly diagnosed and 1,538 had a prior diagnosis of HIV. Factors that may impact the viral suppression status (<200 copies/mL) prior to admission were examined. Median income and percentage of individuals living below poverty were inferred from the American Community Survey (U.S. Census) data based on a patient’s zipcode. All other factors were extracted from the medical record at the time of admission. Chi square tests and t-tests were used to compare patients who were virally suppressed to those who were not. Results The average age was 48 years old and 60% were male and 82% black race. Patients who presented and were not virally suppressed were more likely to be between the ages of 40–60 and of black race. Distributions of age groups and race were significantly different between those virally suppressed and those who were not suppressed at admission (P < 0.05 for both). Blacks and whites between 40 and 60 years were more likely than other race and age groups to present at admission without viral suppression. Patients from geographic areas associated with high poverty and lower median income were less likely to be virally suppressed at admission (23.2% vs. 25.2%; P < 0.05 for poverty and $41,183 vs. $43,757; P < 0.05) for income. Conclusion These results indicate that age, race and geographically inferred income and poverty are significantly different between patients who are virally suppressed at admission and those who have a detectable viral load. Further investigation is needed to better understand how these patient-level factors, including socioeconomics, impact linkage to care as well as how best to allocate resources to better engage and retain patients in HIV care to improve their long-term outcomes. Disclosures All authors: No reported disclosures.

Download Full-text

Continuum of HIV care of newly diagnosed individuals in Israel, 2011–2015: a population-based cohort study

International Journal of STD & AIDS ◽

10.1177/0956462419891023 ◽

2020 ◽

Vol 31 (4) ◽

pp. 326-334

Author(s):

M Chowers ◽

D Chemtob ◽

O Mor ◽

I Levy ◽

D Elbirt ◽

...

Keyword(s):

Linkage To Care ◽

Population Based ◽

International Standards ◽

Hiv Care ◽

Newly Diagnosed ◽

Cd4 Cell Count ◽

Loss To Follow Up ◽

Parallel Increase ◽

Undiagnosed Hiv ◽

Cd4 Cell

Our aim was to assess the linkage to care (LTC) and treatment for people newly diagnosed with HIV in Israel during 2011–2015. The Ministry of Health estimated the annual prevalence of undiagnosed HIV; new diagnoses were identified by the Central Virology Laboratory. Only adult Israeli citizens were included. LTC at HIV centers within 90 days of diagnosis was assessed. Demographic and clinical data were collected from patient files. A total of 1538 individuals were diagnosed in 2011–2015. A moderate improvement over time was observed in the calculated proportions of undiagnosed individuals (23.1–17.3%) but no change occurred in LTC rates (82.6–81%). The proportion of diagnosed patients initiating treatment within six months increased from 54.7% in 2011 to 89.7% in 2015, with a parallel increase in the viral suppression rate from 30.5% in 2011 to 59.9% in 2015. Of 1159 patients with detailed records, 79.4% were men, median age 36 years (16–92), median CD4 cell count 342 cells/µl. Younger age, intravenous drug use, and imprisonment were independent risk factors for loss to follow-up. HIV is diagnosed late in Israel and LTC rates remain stagnated; higher awareness is still needed. Once in care, however, treatment and outcomes were in line with international standards.

Download Full-text

Optimizing linkage to care and initiation and retention on treatment of adolescents with newly diagnosed HIV infection

AIDS ◽

10.1097/qad.0000000000001538 ◽

2017 ◽

Vol 31 ◽

pp. S253-S260 ◽

Cited By ~ 16

Author(s):

Eva Caroline Ruria ◽

Rose Masaba ◽

Judith Kose ◽

Godfrey Woelk ◽

Eliud Mwangi ◽

...

Keyword(s):

Hiv Infection ◽

Linkage To Care ◽

Newly Diagnosed

Download Full-text

Persons Newly Diagnosed with HIV Infection are at High Risk for Depression and Poor Linkage to Care: Results from the Steps Study

AIDS and Behavior ◽

10.1007/s10461-010-9778-9 ◽

2010 ◽

Vol 15 (6) ◽

pp. 1161-1170 ◽

Cited By ~ 96

Author(s):

Ramona Bhatia ◽

Christine Hartman ◽

Michael A. Kallen ◽

James Graham ◽

Thomas P. Giordano

Keyword(s):

High Risk ◽

Hiv Infection ◽

Linkage To Care ◽

Newly Diagnosed ◽

Risk For Depression

Download Full-text

HIV and AIDS in Poland in 2017

Przeglad Epidemiologiczny ◽

10.32394/pe.73.17 ◽

2019 ◽

pp. 179-192

Author(s):

Katarzyna Szmulik ◽

Marta Niedźwiedzka-Stadnik ◽

Magdalena Rosińska

Keyword(s):

Hiv Testing ◽

Low Frequency ◽

Linkage To Care ◽

Hiv Infections ◽

Hiv And Aids ◽

Newly Diagnosed ◽

Hiv Diagnosis ◽

Annual Survey ◽

Diagnosis Rate ◽

Epidemiological Situation

AIM. The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2017 in comparison to the changes in preceding years. MATERIALS AND METHODS. Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. RESULTS. In 2017 there were 1,419 HIV cases newly diagnosed in Poland (diagnosis rate: 3.69 per 100,000), including 51 among non-Polish citizens. The frequency of newly detected HIV infections increased by nearly 8% compared to the previous year and by almost 28% compared to the median in 2011-2015 years. The total number of AIDS cases was 108 (incidence 0.28 per 100,000), and 20 people died from AIDS disease (0.05 per 100,000). New HIV diagnoses were reported mainly among people in age 20 to 39 years (69.5%) and among men (88.5%). Among cases with known transmission route, 69.5% concerned among men who had sexual contact with men (MSM). The percentage of MSM cases, similarly to heterosexual cases decrease in comparison to previous year, relatively by 5.7% and 6.4%. The percentage of AIDS cases diagnosed at the same time with HIV diagnosis increased by 6% percentage points in comparison with 2016 year (from 68% to 74% AIDS cases). CONCLUSION. The most HIV cases are diagnosed among MSM, so prophylactic activities are still needed in this key population. It is also need to increase the number of new cases linkage-to-care and to improve the low frequency in HIV testing rate in all population.

Download Full-text

Time between diagnosis and achievement of virologic suppression in people living with HIV

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab269 ◽

2021 ◽

Author(s):

Danica Joy C Ilagan ◽

Lindsey Eitniear ◽

Kelli Cole ◽

Joan Duggan ◽

Eric Sahloff

Keyword(s):

Treatment Group ◽

Linkage To Care ◽

Clinic Visit ◽

People Living With Hiv ◽

Virologic Suppression ◽

Newly Diagnosed ◽

Hiv Diagnosis ◽

Delayed Treatment ◽

Art Initiation ◽

Rapid Treatment

Abstract Purpose Data support the individual and public health advantages of shortened time intervals between HIV diagnosis, initiation of antiretroviral therapy (ART), and virologic suppression. The time from HIV diagnosis to linkage to care, initiation of ART, and virologic suppression was evaluated in newly diagnosed, ART-naive individuals after structured programmatic changes were implemented to reduce time to virologic suppression (TVS). Methods The retrospective cohort included newly diagnosed, ART-naive adult patients receiving care in a Midwestern Ryan White Clinic. Study periods were between January 1, 2015, and December 31, 2015 (delayed treatment group) and January 1, 2017, and December 31, 2017 (rapid treatment group). Changes during the intervention time period were related to access to care and ART. The primary outcome of time from HIV diagnosis to virologic suppression was compared between the groups. Secondary outcomes included the time from diagnosis to linkage to care and the time to initiation of ART. Results Twenty-four and 35 individuals were included in the control and intervention groups, respectively. Median (interquartile range) time from diagnosis to viral suppression was 137 (77-318) days in the delayed treatment group vs 76.5 (51-151) days in the rapid treatment group (P = 0.021). Time from diagnosis to first clinic visit remained similar (median of 13.5 vs 15 days, P = 0.859), while time from first clinic visit to initiation of ART decreased significantly (median of 15 vs 0 days, P < 0.001). Conclusion Time from first clinic visit to ART initiation was significantly shortened in this intervention and was the driving force to decreasing TVS. Additional research into barriers impacting time from diagnosis to linkage to care are needed to further shorten TVS.

Download Full-text