Factors associated with delayed entry into primary HIV medical care after HIV diagnosis

The aim of the study was to assess the median time between HIV diagnosis and entry into primary HIV medical care in a large urban area and to assess the potential individual, diagnosing facility, and community level factors influencing entry into care. One thousand two hundred and sixty-six individuals diagnosed with HIV in Philadelphia between 1 July 2005 and 30 June 2006 were followed until entry into care through 15 June 2007. Time to entry into care was calculated as a survival time variable and was defined as the time in months between the date of HIV diagnosis and the date more than 3 weeks after diagnosis when a CD4 cell count or percentage and/or HIV viral load were obtained. The median time to entry into care for all individuals was 8 months, with a range of 1-26 months. Factors associated with delayed entry into care included age more than 40 years [hazard ratio (HR) = 0.85; 95% confidence interval (CI) = 0.75-0.97] and diagnosis as an inpatient in the hospital (HR = 0.37; 95% CI = 0.37-0.57). Factors associated with earlier entry into care included Hispanic ethnicity (HR = 1.39; 95% CI = 1.05-1.84), male sex with men as HIV transmission risk factor (HR = 1.27; 95% CI = 1.03-1.56), and residence in a census tract with a high poverty rate (HR = 1.68; 95% CI = 1.22-2.30). Individuals newly diagnosed with HIV in Philadelphia demonstrated marked delays in accessing care highlighting the tremendous need for interventions to improve overall linkage. These interventions should especially be targeted at those aged more than 40 years and those diagnosed in the hospital.