Poor Linkage to Care Despite Significant Improvement in Access to Early cART in Central Poland - Data from Test and Keep in Care (TAK) Project

Justyna D Kowalska; Leah Shepherd; Magdalena Ankiersztejn-Bartczak; Aneta Cybula; Hanna Czeszko-Paprocka; Ewa Firląg-Burkacka; Amanda Mocroft; Andrzej Horban

doi:10.1371/journal.pone.0162739

Poor Linkage to Care Despite Significant Improvement in Access to Early cART in Central Poland - Data from Test and Keep in Care (TAK) Project

PLoS One. 2016 Oct 6;11(10):e0162739. doi: 10.1371/journal.pone.0162739. eCollection 2016.

Authors

Justyna D Kowalska^{1

2}, Leah Shepherd³, Magdalena Ankiersztejn-Bartczak⁴, Aneta Cybula⁵, Hanna Czeszko-Paprocka¹, Ewa Firląg-Burkacka¹, Amanda Mocroft³, Andrzej Horban^{1

2}

Affiliations

¹ Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland.
² Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland.
³ Department of Infection and Population Health, University College London, London, United Kingdom.
⁴ Foundation of Social Education (FES), Warsaw, Poland.
⁵ Medical University of Warsaw, Department of Infectious and Tropical Diseases and Hepatology, Warsaw, Poland.

Abstract

Background: The main objective of the TAK project is investigating barriers in accessing HIV care after HIV-diagnosis at the CBVCTs of central Poland. Here we describe factors associated with and changes over time in linkage to care and access to cART.

Method: Data collected in 2010-2013 in CBVCTs were linked with HIV clinics records using unique identifiers. Individuals were followed from the day of CBVCTs visit until first clinical visit or 4/06/2014. Cox-proportional hazard models were used to identify factors associated with being linked to care and starting cART.

Results: In total 232 persons were diagnosed HIV-positive and 144 (62.1% 95%CI: 55.5-68.3) persons were linked to care. There was no change over time in linkage to care (p = 0.48), while time to starting cART decreased (p = 0.02). Multivariate factors associated with a lower rate of linkage to care were hetero/bisexual sexual orientation, lower education, not having an HIV-positive partner and not using condoms in a stable relationship. Multivariate factors associated with starting cART were lower education, recent year of linked to care, and first HIV RNA and CD4 cell count.

Conclusions: Benefits of linkage to care, measured by access to early treatment, steadily improved in recent years. However at least 1 in 3 persons aware of their HIV status in central Poland remained outside professional healthcare. Persons at higher risk of remaining outside care, thus target population for future interventions, are bi/heterosexuals and those with lower levels of education.

MeSH terms

Adult
Ambulatory Care Facilities / statistics & numerical data
Anti-HIV Agents / therapeutic use*
Female
HIV Infections / drug therapy*
Health Services Accessibility / statistics & numerical data*
Humans
Male
Poland
Proportional Hazards Models

Substances

Anti-HIV Agents

Grants and funding

The TAK project received unrestricted research grants from Research Development Foundation in Hospital for Infectious Diseases, Abbvie Poland and Gilead Sciences Poland. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.