RER and GDK contributed equally to this manuscript and should be considered co-first authors.
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Factors Associated With No or Delayed Linkage to Care in Newly Diagnosed Human Immunodeficiency Virus (HIV)-1–Infected Patients Identified by Emergency Department–based Rapid HIV Screening Programs in Two Urban EDs
Article first published online: 17 MAY 2012
DOI: 10.1111/j.1553-2712.2012.01351.x
© 2012 by the Society for Academic Emergency Medicine
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How to Cite
Rothman, R. E., Kelen, G. D., Harvey, L., Shahan, J. B., Hairston, H., Burah, A., Moring-Parris, D. and Hsieh, Y.-H. (2012), Factors Associated With No or Delayed Linkage to Care in Newly Diagnosed Human Immunodeficiency Virus (HIV)-1–Infected Patients Identified by Emergency Department–based Rapid HIV Screening Programs in Two Urban EDs. Academic Emergency Medicine, 19: 497–503. doi: 10.1111/j.1553-2712.2012.01351.x
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RER and GDK contributed equally to this manuscript and should be considered co-first authors.
Presented at the Society for Academic Emergency Medicine annual meeting, Phoenix, AZ, June 2010.
The Johns Hopkins University Department of Emergency Medicine HIV Testing Program was funded in part by grants from Maryland Department of Health and Mental Hygiene and the Baltimore City Health Department. Supplementary support for expanded HIV testing was funded by grants from The Gilead Foundation.
The authors have no potential conflicts of interest to disclose.
Supervising Editor: Lee Wilbur, MD.
Publication History
- Issue published online: 17 MAY 2012
- Article first published online: 17 MAY 2012
- Received May 31, 2011; revision received September 28, 2011; accepted November 3, 2011.
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ACADEMIC EMERGENCY MEDICINE 2012; 19: 497–503 © 2012 by the Society for Academic Emergency Medicine
Abstract
Objectives: The objective was to describe the proportions of successful linkage to care (LTC) and identify factors associated with LTC among newly diagnosed human immunodeficiency virus (HIV)-positive patients, from two urban emergency department (ED) rapid HIV screening programs.
Methods: This was a retrospective analysis of programmatic data from two established urban ED rapid HIV screening programs between November 2005 and October 2009. Trained HIV program assistants interviewed all patients tested to gather risk behavior data using a structured data collection instrument. Reactive results were confirmed by Western blot testing. Patients were provided with scheduled appointments at HIV specialty clinics at the institutions where they tested positive within 30 days of their ED visit. “Successful” LTC was defined as attendance at the HIV outpatient clinic within 30 days after HIV diagnosis, in accordance with the ED National HIV Testing Consortium metric. “Any” LTC was defined as attendance at the outpatient HIV clinic within 1 year of initial HIV diagnosis. Multivariate logistic regression was performed to determine factors associated with any LTC or successful LTC.
Results: Of the 15,640 tests administered, 108 (0.7%) were newly identified HIV-positive cases. Nearly half (47.2%) of the patients had been previously tested for HIV. Successful LTC occurred in 54% of cases; any LTC occurred in 83% of cases. In multivariate analysis, having public medical insurance and being self-pay were negatively associated with successful LTC (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.12 to 0.96; OR = 0.34, 95% CI = 0.13 to 0.89, respectively); being female and having previously tested for HIV was negatively associated with any LTC (OR = 0.30, 95% CI = 0.10 to 0.93; OR = 0.23, 95% CI = 0.07 to 0.77, respectively).
Conclusions: In spite of dedicated resources for arranging LTC in the ED HIV testing programs, nearly 50% of patients did not have successful LTC (i.e., LTC occurred at >30 days), although >80% of patients were LTC within 1 year of initial diagnosis. Further evaluation of the barriers associated with successful LTC for those with public insurance and self-pay is warranted.