Background Delay between HIV diagnosis and entry into care may have a negative impact on the individual prognosis and may enable further transmission. Insight into duration and determinants of care-delay is important for public health aimed at reducing ongoing HIV transmission.
Methods Prospective data were collected regionally from consenting patients testing HIV positive at the STI clinics in Amsterdam and Rotterdam, from February 2009-December 2011. Logistic regression analyses were performed to assess risk factors for care delay. 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 In total, 310 participants were included in the study (response 70%). The majority were men who have sex with men. Seventy five percent of the study population was referred directly from STI clinic to treatment centre by a clinician or nurse. Thirty percent of participants were delayed: 15% entered care after 4 weeks and 15% had not entered care yet. Thus, 70% of participants entered care within 4 weeks; median time of entry was 9 days (range 0–739 days). In the multivariate model, age below 25 years (OR = 3.6 95% CI 1.9–6.7) and indirect referral (OR = 3.3 95% CI 1.8–6.5) were independent risk factors for care delay, while people with health insurance were less likely to delay (OR = 0.3 95% CI 0.1–0.9). No association was found between care delay and CD4 cell counts or viral load at diagnosis.
Conclusions Younger persons and persons without health insurance are at risk for entering care late after being diagnosed HIV positive. Direct referral from STI clinic to care leads to less delay. Testing of those at risk is not enough to interrupt HIV transmission, entry into care needs to be assured as well. A more active role of the care provider is needed.
- care delay