Role of Country of Birth, Testing Site, and Neighborhood Characteristics on Nonlinkage to HIV Care Among Latinos

AIDS Patient Care STDS. 2018 Apr;32(4):165-173. doi: 10.1089/apc.2018.0021.


The objective of this study was to estimate disparities in linkage to human immunodeficiency virus (HIV) care among Latinos by country/region of birth, HIV testing site, and neighborhood characteristics. A retrospective study was conducted using Florida HIV surveillance records of Latinos/Hispanics aged ≥13 diagnosed during 2014-2015. Linkage to HIV care was defined as a laboratory test (HIV viral load or CD4) within 3 months of HIV diagnosis. Multi-level Poisson regression models were used to estimate adjusted prevalence ratios (aPR) for nonlinkage to care. Of 2659 Latinos, 18.8% were not linked to care within 3 months. Compared with Latinos born in mainland United States, those born in Cuba [aPR 0.60, 95% confidence interval (CI) 0.47-0.76] and Puerto Rico (aPR 0.61, 95% CI 0.41-0.90) had a decreased prevalence of nonlinkage. Latinos diagnosed at blood banks (aPR 2.34, 95% CI 1.75-3.12), HIV case management and screening facilities (aPR 1.76, 95% CI 1.46-2.14), and hospitals (aPR 1.42, 95% CI 1.03-1.96) had an increased prevalence of nonlinkage compared with outpatient general, infectious disease, and tuberculosis/sexually transmitted diseases/family planning clinics. Latinos who resided in the lowest (aPR 1.57, 95% CI 1.19-2.07) and third lowest (aPR 1.33, 95% CI 1.01-1.76) quartiles of neighborhood socioeconomic status compared with the highest quartile were at increased prevalence. Latinos who resided in neighborhoods with <25% Latinos also had increased prevalence of nonlinkage (aPR 1.23, 95% CI 1.01-1.51). Testing site at diagnosis may be an important determinant of HIV care linkage among Latinos due to neighborhood or individual-level resources that determine location of HIV testing.

Keywords: Hispanics; Latinos; human immunodeficiency virus; linkage to care; neighborhood; testing site.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Case Management
  • Continuity of Patient Care / organization & administration*
  • Cuba / ethnology
  • Emigrants and Immigrants*
  • Female
  • Florida / epidemiology
  • Florida / ethnology
  • HIV Infections / diagnosis*
  • HIV Infections / drug therapy
  • HIV Infections / ethnology
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / statistics & numerical data*
  • Hispanic or Latino / statistics & numerical data*
  • Humans
  • Male
  • Mass Screening*
  • Middle Aged
  • Prevalence
  • Puerto Rico / ethnology
  • Residence Characteristics / statistics & numerical data*
  • Retrospective Studies
  • Risk Factors
  • United States / epidemiology
  • Viral Load / drug effects


  • Anti-HIV Agents