"Timely linkage to HIV medical care has the potential to improve individual health outcomes and prevent secondary HIV transmission," though recent research found study design affected estimates of delayed care entry, the authors noted. For example, higher estimates were seen among studies using only HIV case surveillance data.
The authors compared prevalence and risk factors for care delay using data from two New York City-based studies with different designs. The Medical Monitoring Project (MMP) employed a retrospective design to estimate historical delay among persons currently receiving care, while the Never in Care (NIC) study used a prospective design to estimate current delay status among persons who were naive to care at baseline.
Of 513 MMP participants in 2007-08, 23 percent delayed entry into care for more than three months following diagnosis. Independent risk factors for delay of care were earlier year of diagnosis and testing positive in a nonmedical environment. Of 28 NIC participants in 2008-10, more than half tested positive in a nonmedical environment. In both studies, the primary stated reasons for delay were denial of HIV status and perceiving they did not need medical care.
"The strengths and weaknesses of surveillance only, prospective and retrospective study designs with respect to investigating this issue are explored. Future studies and interventions should be mindful of the common selection biases and measurement limitations with each design," the authors concluded. "A triangulation of estimates from varying designs is suggested for accurately measuring care linkage efforts over time."
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