Background Direct treatment after HIV-diagnosis reduces further transmission and has individual health benefits. A check of HIV referral is therefore crucial. Approximately one third of HIV-infections in the greater Rotterdam area are diagnosed at the Center of Sexual Health (CSH). After notification of HIV-infection and counseling, clients are directly referred to a HIV treatment center (HTC). The HTC informs the CSH if the patient did not attend within 4 weeks.
Methods Determinants of linkage to care were assessed in patients with HIV diagnosis (2015–2018). For patients in the Rotterdam HTCs, median time was calculated between testing and diagnosis (T1) and diagnosis and 1st consultation at HTC (T2).
Results HIV-infection was found in 208 patients, (7 women, 14 heterosexual men, 187 MSM (18 of whom bisexual); 120 (58%) had a non-Western migratory background. Nineteen (9%) turned out to be known HIV-positive: 17 of those were in care, 2 were referred again. Of 189 newly diagnosed, 172 (91%) were directly referred by the CSH to a HTC of whom 95%(163/172) entered care. Median T1 decreased from 9 to 6.5 days and median T2 decreased from 8 to 5.5 days respectively in 2015 and 2018. Linkage to care was 86%(163/189), 14%(26/189) were lost to follow-up: 7 went abroad, 10 were untraceable, 8 were referred but did not enter care and 1 could not be verified. Linkage to care was lower for those with a non-Western migratory background compared to Western (79% (83/105) vs 95% (80/84); p=0.002).
Conclusion By a close collaboration between CSH and HTC we were able to improve linkage to care to 86% of new patients, we also observed a decrease in time to care. However, there is a worrisome loss to follow-up, especially in patients with a migratory background. Reasons for loss to follow-up will be investigated, peer involvement may facilitate linkage to care.
Disclosure No significant relationships.
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