National Infection Service, Public Health England, London, UK.
Institute for Global Health, University College London, London, UK.
HIV Med. 2021 Jul;22(6):491-501. doi: 10.1111/hiv.13078. Epub 2021 Feb 2.
We explore trends in linkage to HIV care following diagnosis and investigate the impact of diagnosis setting on linkage in the era of expanded testing.
All adults (aged ≥ 15 years) diagnosed with HIV between 2005 and 2014 in England, Wales and Northern Ireland (EW&NI) were followed up until the end of 2017. People who died within 1 month of diagnosis were excluded (n = 1009). Trends in linkage to outpatient care (time to first CD4 count) were examined by sub-population and diagnosis setting. Logistic regression identified predictors of delayed linkage of > 1 month, > 3 months and > 1 year post-diagnosis (2012-2014).
Overall, 97% (60 250/62 079) of people linked to care; linkage ≤ 1 month was 75% (44 291/59 312), ≤ 3 months was 88% (52 460) and ≤ 1 year was 95% (56 319). Median time to link declined from 15 days [interquartile range (IQR): 4-43] in 2005 to 6 (IQR: 0-20) days in 2014 (similar across sub-populations/diagnosis settings). In multivariable analysis, delayed linkage to care was associated with acquiring HIV through injecting drug use, heterosexual contact or other routes compared with sex between men (> 1 month/3 months/1 year), being diagnosed in earlier years (> 1 month/3 months/1 year) and having a first CD4 ≥ 200 cells/μL (> 3 months/1 year). Diagnosis outside of sexual health clinics, antenatal services and infectious disease units predicted delays of > 1 month. By 3 months, only diagnosis in 'other' settings (prisons, drug services, community and other medical settings) was significant.
Linkage to care following HIV diagnosis is relatively timely in EW&NI. However, non-traditional testing venues should have well-defined referral pathways established to facilitate access to care and treatment.
本研究旨在探讨诊断后与 HIV 护理建立联系的趋势，并研究扩大检测时代下，诊断地点对联系建立的影响。
所有于 2005 年至 2014 年期间在英格兰、威尔士和北爱尔兰（EW&NI）被诊断为 HIV 的成年人（年龄≥15 岁）均被随访至 2017 年底。因诊断后 1 个月内死亡而被排除（n=1009）。通过亚人群和诊断地点来检查门诊护理（首次 CD4 计数时间）的建立联系趋势。逻辑回归确定了延迟联系超过 1 个月、3 个月和 1 年的预测因素（2012-2014 年）。
总体而言，97%（60250/62079）的人建立了联系；1 个月内建立联系的比例为 75%（44291/59312），3 个月内为 88%（52460），1 年内为 95%（56319）。从 2005 年的 15 天（四分位距[IQR]：4-43）到 2014 年的 6 天（IQR：0-20），建立联系的中位数时间下降（所有亚人群/诊断地点相似）。在多变量分析中，与男男性接触或其他途径相比，通过注射吸毒、异性接触或其他途径感染 HIV 与延迟护理建立联系相关（超过 1 个月/3 个月/1 年），在早期年份诊断与延迟护理建立联系相关（超过 1 个月/3 个月/1 年），且首次 CD4 计数≥200 个细胞/μL（超过 3 个月/1 年）。在性健康诊所、产前服务和传染病单位以外的地点诊断与超过 1 个月的延迟有关。到 3 个月时，只有在“其他”地点（监狱、药物服务、社区和其他医疗场所）诊断才具有统计学意义。
在 EW&NI，HIV 诊断后与护理建立联系的时间相对及时。然而，非传统的检测场所应该建立明确的转诊途径，以方便获得护理和治疗。
