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{
    "pk": 8687,
    "title": "Predictors Of Linkage To Care For Newly Diagnosed HIV-Positive Adults",
    "subtitle": null,
    "abstract": "Introduction:\n Linkage to care following a human immunodeficiency virus (HIV) diagnosis is critical. In the U.S. only 69% of patients are successfully linked to care, which results in delayed receipt of antiretroviral therapy leading to immune system dysfunction and risk of transmission to others. Methods: We evaluated predictors of failure to link to care at a large urban healthcare center in Philadelphia in order to identify potential intervention targets. We conducted a cohort study between May 2007 and November 2011 at hospital-affiliated outpatient clinics, emergency departments (EDs), and inpatient units.\nResults:\n Of 87 patients with a new HIV diagnosis, 63 (72%) were linked to care: 23 (96%) from the outpatient setting and 40 (63%) from the hospital setting (ED or inpatient) (p<0.01). Those who were tested in the hospital-based settings were more likely to be black (p=0.01), homeless (p=0.03), and use alcohol or drugs (p=0.03) than those tested in the outpatient clinics. Patients tested in the ED or inpatient units had a 10.9 fold (p=0.03) higher odds of failure to link compared to those diagnosed in an outpatient clinic. When testing site was controlled, unemployment (OR 12.2;p<0.01) and substance use (OR 6.4;p<0.01) were associated with failure to link.\nConclusion:\n Our findings demonstrate the comparative success of linkage to care in outpatient medical clinics versus hospital-based settings. This study both reinforces the importance of routine opt-out HIV testing in outpatient practices, and demonstrates the need to better understand barriers to linkage.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "HIV testing, linkage to care, outpatient primary care HIV testing, emergency room HIV testing"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/2pz6z3sg",
    "frozenauthors": [
        {
            "first_name": "Erika",
            "middle_name": "",
            "last_name": "Aaron",
            "name_suffix": "",
            "institution": "Drexel University College of Medicine, Division of Infectious Diseases and HIV \nMedicine, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Tyler",
            "middle_name": "",
            "last_name": "Alvare",
            "name_suffix": "",
            "institution": "George Washington University School of Medicine and Health Sciences, Washington, DC",
            "department": "None"
        },
        {
            "first_name": "Ed",
            "middle_name": "J.",
            "last_name": "Gracely",
            "name_suffix": "",
            "institution": "Drexel University School of Public Health, Epidemiology and Biostatistics, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Ralph",
            "middle_name": "",
            "last_name": "Riviello",
            "name_suffix": "",
            "institution": "Drexel University College of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Amy",
            "middle_name": "",
            "last_name": "Althoff",
            "name_suffix": "",
            "institution": "Drexel University College of Medicine, Division of Infectious Diseases and HIV \nMedicine, Philadelphia, Pennsylvania",
            "department": "None"
        }
    ],
    "date_submitted": "2015-01-04T15:14:01Z",
    "date_accepted": "2015-01-04T15:14:01Z",
    "date_published": "2015-06-22T07:00:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/8687/galley/4988/download/"
        }
    ]
}