Background Delay between HIV diagnosis and entry into care may impact not only on the individual prognosis, but hinders interruption of further HIV transmission. Insight into duration and determinants of care-delay and differences between those who do and do not delay are important to further public health policy aimed at reducing ongoing HIV transmission.
Methods (1). Data from the ATHENA national observational cohort for HIV patients with a first date of care from January 2008 until May 2010 were analysed to assess place, date of initial positive diagnosis and entry date into care. (2). Prospective data collection is set up regionally from consenting patients testing HIV positive at the STI clinics in Amsterdam and Rotterdam. Results from February 2009 until April 2010 for time into care and delay are presented. For this analysis delay of entry into care is defined as a time period of 4 weeks or more between confirmed HIV diagnosis and first consultation at the HIV treatment centre.
Results (1). At the national level, 28% of all new patients entering care (n=2775) was diagnosed HIV positive at their GP, 25% at an STI clinic, 23% in the hospital, 2% at the pregnancy screening, 4% abroad, 4% other and 14% unknown. Median number of days between HIV diagnosis and entry into care was 19 days (IQR 7–49 days). In 16% of patients time to enter care took over 150 days; those infected by heterosexual contact or injecting drug use were more likely to be in this group. Patients born outside the Netherlands were also more likely to enter care late. 2). From February 2009 until April 2010, 120 participants were included in the study (response 70%). The majority (n=108) were men who have sex with men (MSM). For 78% of participants a date of entry into care was known; median time into care was 8 days (range 0–104 days). Twenty two per cent had not entered care yet of whom 16% had CD4 cell counts below 350. Of participants who were directly referred to an HIV treatment 10% delayed for medical care compared to 45% of participants wanted to make an appointment on their own initiative.
Conclusions Specific subpopulations such as heterosexuals and ethnic minorities are at risk for entering care late after being diagnosed HIV positive. Results from the prospective study show that direct referral from STI clinic to an HIV treatment centre leads to less delay. Testing of those at risk is not enough to interrupt HIV transmission chains, entry into care needs to be assured as well.
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