Croxford, Sara Evelyn;
(2020)
Linkage to care following HIV diagnosis in Europe.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background: Attendance for clinical care promptly after diagnosis with human immunodeficiency virus (HIV) is important; delayed linkage to care and treatment has implications for the health of the individual and the public. In this thesis, I have explored entry into care in the World Health Organization European Region with an aim to inform and optimise public health monitoring. Methods: I utilised data from the literature and HIV surveillance data from Europe and England, Wales and Northern Ireland (EW&NI) to describe linkage to care and risk factors for poor linkage. I carried out a key informant survey of national HIV surveillance focal points to understand the context within which linkage occurs in Europe and investigate the current capacity of countries to monitor linkage to care for public health purposes. Results: Overall, 38/53 countries from Europe were able to contribute routinely collected CD4 data to this, the first European estimate of linkage to care; 80% of included HIV diagnoses made between 2014 and 2016 were ever linked to care, 73%-92% within three months of diagnosis. However, linkage varied widely by region. Several groups were identified as being at higher risk of delayed linkage to care: people who acquired HIV through injecting drug use or heterosexual contact (Europe), people of younger age at diagnosis (Western Europe), migrants (Western Europe), people who had a higher first CD4 count (Western Europe) and people diagnosed outside of sexual health clinics (EW&NI). The survey identified a number of barriers to using surveillance data to monitor linkage to care, but ultimately validated the use of CD4 as a proxy for care entry. Conclusion: The findings of this thesis have implications for public health action and have informed the development of monitoring of linkage to care at the European Centre for Disease Prevention and Control and Public Health England.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Linkage to care following HIV diagnosis in Europe |
| Event: | UCL |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10117946 |
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