Objectives: To describe linkage to HIV care following diagnosis in Europe and to identify factors associated with delayed linkage. Methods: We analysed data of adults (aged ≥ 15 years) diagnosed with HIV from 2010 to 2014 in 31 European countries. Linkage to care was calculated using the time between HIV diagnosis and first CD4 count. Linkage was considered delayed if the CD4 count was taken more than 3 months after diagnosis. Logistic regression was used to determine factors for delayed linkage. Results: Of the 120 129 adults diagnosed from 2010 to 2014, 4560 were previously diagnosed elsewhere, 808 died within 3 months of diagnosis and 54 731 people were missing CD4 count and/or date information. Among the 60 030 people included, linkage to care within 3 months was 96%. A lower bound (LB) for this was 55%, when those missing CD4 data were assumed not to be linked. Prompt linkage varied significantly by region [Western: 97% (LB: 65%); Central: 90% (LB: 65%); Eastern: 91% (LB: 11%)] and risk group. In multivariable analysis, delayed linkage to care was associated with: acquiring HIV through injecting drug use/heterosexual contact, being diagnosed in Central/Eastern Europe and having a first CD4 count > 200 cells/μL. People of older age at diagnosis and those diagnosed after 2011 were more likely to be linked promptly. Associations differed by region. Conclusions: Among those with CD4 data available, linkage to care is prompt. However, HIV surveillance must be strengthened and data quality improved, particularly in Eastern Europe. Our findings highlight disparities in care access and significant differences between regions.
Bibliographical noteFunding Information:
1Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK, 2Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, Mortimer Market Centre, London, UK, 3Royal Free London NHS Foundation Trust, London, UK, 4European Centre for Disease Prevention and Control, Solna, Sweden and 5World Health Organization Regional Office for Europe, UN City, Copenhagen, Denmark
These analyses were co-funded by the European Commission and Public Health England as part of the OptTEST project by HIV in Europe (Grant #: 20131102). We would like to acknowledge the ECDC, the WHO Regional Office for Europe and the ECDC/WHO national focal points for their pivotal role in the surveillance of HIV in Europe. We would also like to thank collaborators at University College London, the European HIV Surveillance Network, OptTEST and Public Health England for their scientific input.
© 2018 Crown copyright. HIV Medicine © 2018 British HIV Association.
- linkage to care