P17.24 Delayed linkage to care in a third of hiv positive individuals in the netherlands: opportunities to improve the second step in the cascade of care

Abstract

Introduction The HIV cascade of care can identify missed opportunities to optimise control. The first step entails early testing, the second step is to ensure prompt linkage to care once diagnosed. To determine time to linkage to HIV-care following diagnosis at an STI centre, and to identify risk factors for delayed linkage. Methods Patients newly diagnosed with HIV at STI clinics in the Netherlands were followed until linkage to care. Data were collected at time of diagnosis and at first consultation in care, including demographics, behavioural information, CD4+ counts and HIV viral load measurements. Delayed linkage to care was defined as >4 weeks between HIV diagnosis and first consultation. Results 310 participants were included; the majority (90%) men who have sex with men. For 259 participants (84%) a date of first consultation in care was known; median time to linkage was 9 days (range 0-435). Overall, 95 (31%) of participants were not linked within 4 weeks of diagnosis; among them, 44 were linked late and 51 were not linked at all by the end of study follow-up. Being young (<25 yrs), having a non-Western ethnicity or lacking health insurance were independently associated with delayed linkage to care. Also, those being referred to care indirectly were more likely to have delayed linkage. Baseline CD4+ count, viral load, perceived social support and stigma at diagnosis were not associated with delayed linkage. Risk behaviour and CD4+ counts declined between diagnosis and linkage to care. Conclusions Although most newly diagnosed HIV patients were linked to care within 4 weeks, delay was observed for a third, with over half of them not yet linked at the end of follow-up. Vulnerable subpopulations (young, uninsured, ethnic minority) were at risk for delayed linkage. Testing those at risk is not sufficient, timely linkage to care needs to be assured.