The therapeutic implications of timely linkage and early retention in XXXX care.

@entity1 @entity404 @entity645 @entity791 @entity734
Following @entity645 diagnosis, linkage to outpatient treatment, antiretroviral initiation, and longitudinal retention in care represent the foundation for successful treatment. While prior studies have evaluated these processes in isolation, a systematic evaluation of successive steps in the same cohort of @entity1 has not yet been performed. To ensure optimal long-term outcomes, a better understanding of the interplay of these processes is needed. Therefore, a retrospective cohort study of @entity1 initiating outpatient care at the University of Alabama at Birmingham 1917 @entity645 = @entity791 Clinic between January 2000 and December 2005 was undertaken. Multivariable models determined factors associated with: late diagnosis=linkage to care (initial @entity404 < 350 cells=mm3), timely antiretroviral initiation, and retention across the first two years of care. Delayed linkage was observed in two-thirds of the overall sample (n = 567) and was associated with older age (odds ratio [OR] = 1.31 per 10 years; 95%confidence interval [CI] = 1.06-1.62) and African American race (OR = 2.45; 95% CI = 1.60-3.74). Attending all clinic visits (hazard ratio [HR] = 6.45; 95% CI = 4.47-9.31) and lower initial @entity404 counts led to earlier antiretroviral initiation. Worse retention in the first 2 years was associated with younger age (OR = 0.68 per 10 years;95% CI = 0.56-0.83), higher baseline @entity404 count, and @entity734 (OR = 1.78; 95% CI = 1.16-2.73). Interventions to improve timely @entity645 diagnosis and linkage to care should focus on older @entity1 and African Americans while efforts to improve retention should address younger @entity1 , those with higher baseline @entity404 counts, and @entity734 . Missed clinic visits represent an important obstacle to the timely initiation of antiretroviral therapy. These data inform development of interventions to improve linkage and retention in @entity645 care, an emerging area of growing importance.
