Time to linkage to care and viro-immunologic parameters of individuals diagnosed before and after the 2006 HIV testing recommendations.

Objectives: To assess the time from linkage to care and viro-immunologic parameters before and after implementation of the Centers for Disease Control and Prevention's 2006 revised human immunodeficiency virus (HIV) testing strategy.

Methods: Case reports from South Carolina's enhanced HIV/AIDS (acquired immunodeficiency syndrome) Reporting System were used to compare time to linkage to care and viro-immunologic indicators at diagnosis and 1 year after diagnosis of HIV in individuals diagnosed between 2004 and 2006 (n = 2456) with those diagnosed between 2008 and 2010 (n = 2118). CD4 T-cell count/percent and viral load tests were used as a proxy for a clinical visit and to determine disease stage.

Results: Individuals diagnosed between 2008 and 2010 were less likely than those diagnosed between 2004 and 2006 to be in care after 12 months than within 3 months of HIV diagnosis (adjusted odds ratio [AOR] 0.42, 95% confidence interval [CI] 0.34-0.51). Individuals diagnosed between 2008 and 2010 were more likely than those diagnosed between 2004 and 2006 to have high CD4 T-cell counts (>500 cells per cubic millimeter than ≤200 cells per cubic millimeter; AOR 1.24, 95% CI 1.01-1.51) and have undetectable viral loads 1 year post-HIV diagnosis (AOR 8.42, 95% CI 6.96-10.18). Although period of diagnosis did not predict disease stage 1 year post-HIV diagnosis (AOR 0.99, 95% CI 0.87-1.13), there was a decrease from 13% between 2004 and 2006 to 10% between 2008 and 2010 in the percentage of HIV-only patients at diagnosis who progressed to AIDS 1 year post-HIV diagnosis.

Conclusions: Implementation of routine, opt-out HIV testing resulted in more timely linkage to care and improved viro-immunologic parameters 1 year postdiagnosis when compared with the previous testing recommendations.