Foreign-born status as a predictor of engagement in HIV care in a large US metropolitan health system

ABSTRACT

We sought to determine the linkage to and retention in HIV care after HIV diagnosis in foreign-born compared with US-born individuals. From a clinical data registry, we identified 619 patients aged ≥18 years with a new HIV diagnosis between 2000 and 2012. Timely linkage to care was the proportion of patients with an ICD-9 code for HIV infection (V08 or 042) associated with a primary care or infectious disease physician within 90 days of the index positive HIV test. Retention in HIV care was the presence of an HIV primary care visit in each 6-month period of the 24-month measurement period from the index HIV test. We used Cox regression analysis with adjustment for hypothesized confounders (age, gender, race/ethnicity, substance abuse, year, and location of HIV diagnosis). Foreign-born individuals comprised 36% (225/619) of the cohort. Index CD4 count was 225/µl (IQR 67–439/µl) in foreign-born compared with 328/µl (IQR 121–527/µl) in US-born individuals (p < .001). The proportion linked to care was 87% (196/225) in foreign-born compared with 77% (302/394) in US-born individuals (p = .002). The adjusted hazard ratio of linkage to HIV care in foreign-born compared with US-born individuals was 1.28 (95% confidence interval [CI], 1.05–1.56). Once linked, there was no difference in retention in care or virologic suppression at 24 months. These results show that despite late presentation to HIV care, foreign-born persons can subsequently engage in HIV care as well as US-born persons. Interventions that promote HIV screening in foreign-born persons are a promising way to improve outcomes in these populations.

KEYWORDS:

• Immigrant health
• foreign born
• HIV/AIDS
• outcomes
• linkage to care
• engagement in care

Acknowledgements

The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health. These data were presented in part at the 10th International Conference on HIV treatment and Prevention Adherence, on June 28, 2015, Miami, Florida. Study procedures were approved by Partners HealthCare Human Research Committee (Boston, Massachusetts, USA).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The work was supported by the US National Institute of Mental Health [K23 MH100978]; National Institute of Allergy and Infectious Diseases [R01 AI042006]; Harvard University Center for AIDS Research [P30 AI060354]; Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award KL2 TR001100; and the Harvard Medical School Eleanor and Miles Shore 50th Anniversary Award.