Title: New diagnosis HIV linkage to care evaluation in Southeastern United States: A retrospective cohort study 

Background: The HIV epidemic has disproportionally impacted the southern US states, specifically, South Carolina with its estimated 20,000 residents living with HIV/AIDs. To combat this epidemic, the Ending the HIV Epidemic in the US initiative was published with 4 main pillars: diagnose HIV as early as possible, treat HIV rapidly to reach viral load suppression (<200 copies/L) (VS), prevent new HIV transmissions, and respond quickly to HIV outbreaks. New guidelines recommend initiating rapid antiretroviral therapy (ART) within 7 days of HIV diagnosis compared to the traditional goal of 30 days. This study investigated time to patient notification of positive HIV result, linkage to care, ART initiation, and achievement of VS in the SC Midlands.

Methods: We retrospectively analyzed new HIV diagnoses from Prisma Health Midlands locations from 2022-2023. Descriptive statistics were used to analyze time to notifying patient of result, to first evaluation by HIV provider, to ART initiation, and to VS in both the inpatient and outpatient setting.

Results: Among 91 patients newly diagnosed with HIV, 82.4% (75/91) were notified of results within 7 days and 69.2% (63/91) within 72 hours. For the remaining 16 patients, 15 were unreachable by phone after an average 3.2 attempts per patient. Eventually, 96.7% (88/91) were made aware of their diagnosis. Of 71 patients that established care with Prisma Health Immunology Center (PHIC), 33 were first evaluated by an HIV provider while inpatient and 38 in the outpatient clinic. Only 63.6% (21/33) of the patients evaluated inpatient initiated ART within 7 days of diagnosis, predominantly due to provider’s choice to wait until outpatient follow-up. For those with initial evaluation at PHIC, 47.4% (18/38) were seen within 7 days of diagnosis and 94.7% (36/38) were seen within 30 days. All patients initially seen outpatient were started on ART during their first appointment. Overall, for patients that established with PHIC, 67.6% (48/71) saw an HIV provider and 53.5% (38/71) initiated ART within 7 days of diagnosis. Nearly all patients (94.3%, 67/71) saw an HIV provider and (91.5%, 65/71) initiated ART within 30 days. For patients established with PHIC, 85.9% (61/71) achieved VS, averaging 97.15 days from diagnosis to VS. Patient non-adherence was the most common reason for not achieving VS.

Conclusion: While almost all patients with new HIV diagnosis were linked to care and started ART within 30 days of diagnosis, only about half were started within 7 days. This study highlights opportunities to reduce this timeline by prioritizing patient contact information collection during medical encounters, considering point-of-care testing when applicable, standardizing inpatient HIV medication initiation protocols, and evaluating barriers to timely clinic referrals. Future studies with larger sample sizes could assess for demographic risk factors and system-based barriers leading to these delays.