Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Engagement in HIV care is important for optimal clinical outcomes and reductions in transmission, particularly in Southern states. Delayed care initiation remains prevalent. While individual-level risk factors are established, barriers to prompt care initiation associated with characteristics of HIV testing facilities are not well defined. Upon care initiation, persons may benefit from the provision of case management services. Little has been published about whether case management services reduce depression or improve ART adherence. We analyzed 2015 enhanced HIV/AIDS Reporting System data for North Carolina (NC) to estimate the cumulative incidence of persons initiating HIV care by time since diagnosis and in relation to (1) patient-level characteristics and (2) characteristics of the facility where HIV was diagnosed. Of 1,269 adults newly diagnosed in 2015, 84.9% were linked to care < three months from diagnosis; 63% initiated care within one month. Initiating care at ≥ three months was associated with younger age, IDU transmission, diagnosis at a site without co-located HIV care among males but not females, diagnosis at a facility with a higher diagnosis volume, and diagnosis at a sexually transmitted disease clinic (STD), HIV counseling and testing site, or a non-traditional testing facility setting such as a jail. For the examination of persons in HIV care, we used NC data for 2009-2013 from the Medical Monitoring Project. Depression prevalence was higher among the 53.2% who had received case management services than among those who had not, though the adjusted association was observed only among patients living above the poverty level. No differences in ART adherence were observed by receipt of case management services. Though ART adherence was high overall, depressed persons with HIV were less likely to be adherent. HIV clinicians, case managers, and intervention specialists working with persons diagnosed at high volume STD clinics, HIV counseling and testing sites, and non-traditional testing facilities should be provided with resources to ensure persons are promptly enrolled in care. Depression persisted, suggesting the need for resources for case managers, providers, and mental health professionals. Combining data sources for persons living with HIV will be essential to monitor the HIV continuum in NC.