Concordance of HIV surveillance and medical record data: What do CD4 and viral loads not tell us about linkage to HIV care ?. Charu Sabharwal, MD MPH Medical Director Epidemiology and Field Services Program Bureau of HIV/AIDS Prevention and Control NYC Department of Health.
Concordance of HIV surveillance and medical record data: What do CD4 and viral loads not tell us about linkage to HIV care?
Charu Sabharwal, MD MPH
Epidemiology and Field Services Program
Bureau of HIV/AIDS Prevention and Control
NYC Department of Health
National HIV/AIDS Strategy
HIV Continuum of Care
Das, MoupaliPrevention of HIV Acquisition: Behavioral, Biomedical, and Other Interventions.
1Health Resources and Services Administration. The HIV/AIDS Program: HAB Performance Measures Group 1. In; 2009. 2DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. In; 2012. 3 CSTE Position statement 04-ID-07
1 BertolliA. et al The Open AIDS Journal 2012,6:131-141. 2Keller et al. J Acquir Immune DeficSyndr2013.
3New York City HIV/AIDS Surveillance Slide Sets. http://www.nyc.gov/html/doh/html/data/epi-surveillance.shtml
1° Objective – evaluate the correspondence between a patients 1st CD4/VL on/after HIV diagnosis and linkage HIV care
Validate 1st lab test (CD4/VL) from the diagnosing facility as measure of timely linkage toHIV care
Figure 1: Final study population
3,536 new, confirmed HIV diagnoses
among > 13 years in NYC in 2009
1,263 (36%) patients reported from high-volume
(> 20 diagnoses) co-located HIV care sites
947 (75%) patients had 1st CD4/VL reported
from co-located site within 12 months of diagnosis eligible for medical record (MR) abstractions
165 (17%) excluded: MR unavailable
782 (83%) patients
Registry (1st CD/VL) and MR (care visit) data
Linkage within 12 months, per Registry
HIV care visit confirmed by MR
No medical visit group
Medical visit group
No Medical visit
Table 1: Demographics/clinical outcomes
No medical visit
Timely Linkage to Care
True linkage event
(HIV care visit):
Are labs within the early
post-diagnostic period indicative of timely linkage to care?
1 day (IQR 0-5 days)
Figure 8: Performance of Registry data
Refinement of NYC’s timely linkage to care indicator
No lag applied