1. Test and Keep in Care
Factors influencing linkage to care after HIV diagnosis in central Poland – Preliminary results from Test and Keep in Care (TAK) project
Magdalena Ankiersztejn-Bartczak, Ewa Firlag-Burkacka, Hanna Czeszko-Paprocka, Joanna Kubicka, Aneta Cybula, Alicja Wiercińska-Drapało, Andrzej Horban and Justyna D. Kowalska

2. Rationales Prevalence of late presentation is high in Europe
Linkage to care after HIV diagnosis remains underinvestigated
Systems of HIV care and testing strategies need adjustment to changing face of HIV epidemic in Europe
Antinori A. HIV Med 2011, Mocroft A. PLoS 2013, Johnson M. Antivir Ther 2010

3. TAK project objectives
identifying prevalence of HIV-positive persons lost or late to care in central region of Poland
investigation of factors related to it in order to target effective interventions
prospective follow-up of HIV persons linked to care

4. the result not received
Methods
Flow chart lost to care
Counselling
ELISA +
the result not received
Lost to care
WB+
Decoding
not agree
Clinic
not come

5. Methods
data from anonymous HIV testing facilities (2010 and 2011) and HIV clinics were linked using unique Western-Blot number
latest data check for clinics was
persons not registered in clinics’ databases were considered lost to care

6. Methods
Chi-squared and Kruskal-Wallis tests were used for group comparison as appropriate (tests of significance were two-sided)
A multivariable logistic regression model was developed including all variables with p< 0.1 in univariable models
Confidence interval (CI) of 95% was accepted

7. Results General characteristics of the group
110 persons were diagnosed HIV-positive,
90.9% living in central Poland,
4.6% female,
78 (70.9%) MSM and 12(10.9%) bisexual,
Median age was 26.7 (IQR: ) years.

8. the result not received
Results
Flow chart lost to care
Counselling
ELISA +
the result not received
N=7, 6%
WB+
Lost to care
Decoding
not agree
Clinic
not come

9. the result not received
Results
Flow chart lost to care
Counselling
ELISA +
the result not received
N=7, 6%
WB+
N=13, 12%
Decoding
not agree
Lost to care
Clinic
not come

10. the result not received
Results
Flow chart lost to care
Counselling
ELISA +
the result not received
N=7, 6%
WB+
N=13, 12%
Decoding
not agree
Clinic
not come
Lost to care

11. the result not received
Results
Flow chart lost to care
Counselling
ELISA +
the result not received
N=7, 6%
WB+
N=13, 12%
Decoding
not agree
Clinic
not come
N=20, 18%

12. the result not received
Results
Flow chart lost to care
Counselling
ELISA +
the result not received
N=7, 6%
WB+
N=13, 12%
Decoding
not agree
Clinic
not come
N=20, 18%
N=47, 42%

13. Results Of those who registered:
75% showed within one month from HIV diagnosis
54% were late presenters*.
*according to definition by European Late Presenter Consensus Working Group.HIV Med 2011

14. Results Persons LTC were: Characteristic In care n(%) Not in care n(%)
P value
63 (100.0)
47 (100.0)
Gender (female)
1 (1.6)
4 (8.5)
0.2
Age
29.0 ( )
24.9 ( )
0.21
Higher education
52 (82.5)
35 (74.5)
0.3
Testing
HIV test ever
50 (79.4)
33 (70.2)
0.27
No of tests in the past
1 (1-2)
1 (0-2)
0.13
Last test in anonymous testing facility
40 (63.5)
22 (46.8)
0.08
Partner tested
24 (38.1)
19 (40.4)
0.8
There is no significant different between demographic characteristicc

15. Results Persons LTC were: Characteristic In care n(%) Not in care n(%)
P value
63 (100.0)
47 (100.0)
Gender (female)
1 (1.6)
4 (8.5)
0.2
Age
29.0 ( )
24.9 ( )
0.21
Higher education
52 (82.5)
35 (74.5)
0.3
Testing
HIV test ever
50 (79.4)
33 (70.2)
0.27
No of tests in the past
1 (1-2)
1 (0-2)
0.13
Last test in anonymous testing facility
40 (63.5)
22 (46.8)
0.08
Partner tested
24 (38.1)
19 (40.4)
0.8
There is no significant different between demographic characteristicc

16. Results Persons LTC were
Characteristic
In care n(%)
Not in care n(%)
P value
Risk factors
HIV-positive partner
21 (33.3)
7 (14.9)
0.03
Sexual orientation
0.02
Heterosexual
7 (11.1)
13 (27.7)
MSM
51 (80.9)
27 (57.4)
Bisexual
5 (7.9)
Stable relationship last year
9 (19.1)
0.24
Over 20 sexual partners ever
35 (55.6)
17 (36.2)
0.04
Condom use in stable relationship (any)
39 (61.9)
15 (31.9)
0.002
Condom use in casual sex (always or frequent)
45 (71.4)
25 (53.2)
0.05
STI
17 (27.0)
8 (17.0)
0.22
more likely to have hetero- or bisexual orientation, >20 sexual partners ever, not being in relation with HIV-positive partner, not using condoms, having first HIV test.

17. Results Persons LTC were
Characteristic
In care n(%)
Not in care n(%)
P value
Risk factors
HIV-positive partner
21 (33.3)
7 (14.9)
0.03
Sexual orientation
0.02
Heterosexual
7 (11.1)
13 (27.7)
MSM
51 (80.9)
27 (57.4)
Bisexual
5 (7.9)
Stable relationship last year
9 (19.1)
0.24
Over 20 sexual partners ever
35 (55.6)
17 (36.2)
0.04
Condom use in stable relationship (any)
39 (61.9)
15 (31.9)
0.002
Condom use in casual sex (always or frequent)
45 (71.4)
25 (53.2)
0.05
STI
17 (27.0)
8 (17.0)
0.22
more likely to have hetero- or bisexual orientation, >20 sexual partners ever, not being in relation with HIV-positive partner, not using condoms, having first HIV test.

18. Results: Odds ratios for being lost to HIV care
unadjusted adjusted*
LAST TEST IN ATF
TESTS IN PAST
CONDOM OCCAS. REL
CONDOM STABLE REL
>20 PARTNERS EVER
MSM
PARTNER HIV+
AGE
decreasing odds of lost to care
increasing odds of lost to care
*Adjusted for all above

19. Results: Odds ratios for being lost to HIV care
unadjusted adjusted*
LAST TEST IN ATF
TESTS IN PAST
CONDOM OCCAS. REL
CONDOM STABLE REL
>20 PARTNERS EVER
MSM
PARTNER HIV+
AGE
decreasing odds of lost to care
increasing odds of lost to care
*Adjusted for all above

20. Conclusions
integration into care after HIV diagnosis needs improvement
disregarding health risk in sexual contacts increases the odds of being lost to care
broadening awareness and counseling may have an impact on linkage to professional healthcare services

21. Acknowledgments research grant received from
data from testing facilities were provided by National AIDS Centre (Krajowe Centrum AIDS)