Beneficial health outcomes among HIV infected persons are a main goal of our prevention and medical care efforts. Early linkage to care and consistent engagement can lead to better personal health among infected persons and fewer transmissions to uninfected partners. NY Links tracks linkage to care within 30 days, 60 days, three months, and one year of HIV diagnosis. Assessing linkage at several time points gives a more detailed picture of linkage to care. The following graphic, which shows NY Links providers in the Western New York State (WNYS) Ryan White Region, is an example of one way that linkage to care can be assessed over time.
Medical care visits are not available in surveillance data. Instead, laboratory reports of CD4 and viral load testing collected by the New York State HIV surveillance data system are used as indicators of HIV-related medical contact. Medical care visits that did not result in one of these tests are not captured in the data. In addition, the data presented here represent linkage prior to the start of NY Links collaborative activities.
As expected, the proportion of newly diagnosed cases linked to care increases with increasing time after diagnosis (i.e., linkage within 12 months (green line), is higher than linkage within three months (red line) which is higher than linkage within 60 days (purple line) etc.). Across the 13 quarters shown, entry to care within 30 days of diagnosis ranged from 40% in April-June 2010 to 80% in January-March 2011. By one year after diagnosis, 78% (October-December 2011) to 97% (January-March 2011) of newly diagnosed persons were linked to care.
The low percentages of newly diagnosed persons who link to care within 30 days of diagnosis indicate that early linkage to care is challenging. Among the reasons is the time required for providers to receive laboratory confirmation of HIV infection and patient and clinic factors that affect appointment scheduling. Further, the data show that even after a full year beyond diagnosis, some persons are still not linked to medical care. In fact, almost 1 out of 10 newly diagnosed persons in New York State (NYS) in 2011 did not link to care in the first year after diagnosis. Therefore, 100% remains an aspirational goal. The National HIV/AIDS strategy has specified a practical goal of 85% linked to care within three months of HIV diagnosis by 2015. This goal appears within reach for NYS. In 2011, 82% of newly diagnosed persons in NYS were linked to care within three months of diagnosis.
Written by Carol-Ann Watson