BACKGROUND: The 2020 National HIV/AIDS Strategy linkage to care (LTC) measure for newly diagnosed HIV patients changed from LTC within 3 months to within 1 month of diagnosis, reflecting the importance of rapid linkage. Jurisdictions assess LTC with HIV surveillance data, using CD4 and viral load (VL) tests as proxies for HIV care. Our objectives were to examine the impact of counting persons with tests on the day of diagnosis as linked, regardless of timing of subsequent tests, and to examine outcomes among persons with tests on day of diagnosis according to timing of subsequent tests.
METHODS: For Georgia residents newly diagnosed with HIV in 2014, we calculated standard LTC: percent of new diagnoses with CD4 or VL tests within 30 days of the diagnosis date, including those with labs on the day of diagnosis; and modified LTC: percent of new diagnoses with CD4 or VL tests within 30 days, and next test within 90 days for the subset with tests on the day of diagnosis to account for providers potentially not repeating tests within 30 days if performed at diagnosis. For the subset with day of diagnosis tests, logistic regression models were fit to assess relationships between timing of next test and retention in care (≥2 tests at least 90 days apart) and viral suppression (last VL<200 copies/ml) in the 3-15 months following diagnosis, controlling for age at diagnosis, sex, race/ethnicity, and HIV risk factor.
RESULTS: Of the 2,428 patients diagnosed in 2014, 918 (37.8%) had CD4 and/or VL tests on their diagnosis date. Of these 918 patients, 311 (33.9%) had a 2nd test within 30 days, 254 (27.7%) between 30 and 90 days, and 353 (38.5%) after 90 days or never. LTC was 69% using the standard measure and 59% using the modified measure. Among patients with day of diagnosis tests, those with a 2nd test within 90 days had higher odds of retention in care [adjusted odds ratio (AOR): 3.91 (95% confidence interval: 2.93-5.22)] and of achieving viral suppression [AOR: 2.99 (2.26-3.96)], compared to patients with a 2nd test after 90 days or never.
CONCLUSIONS: Patients with tests on the day of diagnosis are a heterogeneous group. In Georgia, a high proportion of newly diagnosed patients have CD4/VL tests performed on the day of diagnosis; the standard linkage measure over-represents the percentage of patients achieving effective linkage, as reflected by outcomes metrics. Alternative measures should be explored.