Direct collaboration between hospitals and NGOs, an essential tool to reinforce linkage to care in People living with HIV

Direct collaboration between hospitals and NGOs, an essential tool to reinforce linkage to care in People living with HIV | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Direct collaboration between hospitals and NGOs, an essential tool to reinforce linkage to care in People living with HIV Teresa Aldámiz-Echevarria, Chiara Fanciulli, Monica Lopez, Leire Perez, and 21 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4862637/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Jan, 2025 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract With the aim of improving access and engagement to healthcare in people living with HIV (PLHIV), in 2022 Gregorio Marañón Hospital and the NGO COGAM developed a circuit for recruitment and referral to hospital. Program targeted PLHIV who were neither receiving antiretroviral treatment (ART) nor on medical follow-up (FU); but also, individuals at risk who underwent screening tests at the NGO and, if positive, were referred for confirmation. The result was an increase in annual new PLHIV seen in hospital by reaching a population who were, essentially, young men (94% male, median age 30 years), migrants (95%) with recent diagnosis of HIV (median 5 years) and who were recently arrived in Spain (median 5 months). Most of them hadn´t healthcare coverage (78%). In multivariate analysis, that included all PLHIV seen for the first time in the ID Unit between 2019 and 2022, lack of healthcare coverage was the only independent predictor of lost to FU that reached statistical significance (HR 5.19, CI 2.76–9.47). Furthermore, time from HIV diagnosis to ART initiating was shortened from 14 to 6 days without affecting linkage to care. Our conclusion is that collaboration with NGOs reinforce diagnosis, FU, and adherence to ART for PLHIV. HIV linkage-to-care access to antiretroviral treatment migrants NGO Figures Figure 1 Figure 2 BACKGROUND HIV treatment regimens have progressively gained in effectiveness and tolerability over the decades. Therefore, nowadays and worldwide, virological failure normally isn’t due to inefficacy of antiretroviral treatment regimen but rather to lack of access to medication or poor therapeutic adherence. It has been demonstrated that undetectable viral load in people living with HIV (PLHIV) suppress viral transmission [ 1 – 2 ]; and moreover, it radically reduces mortality, both for HIV related diseases but also for non-HIV related conditions [ 3 ]. UNAIDS has set global targets to be achieved by 2030: 95% of HIV-infected patients will be diagnosed; 95% of those diagnosed will be on antiretroviral treatment; 95% of them will reach undetectable HIV viral load (95-95-95) [ 4 – 5 ]. Achieving these goals will depend, therefore, not on the emergence of new antiretroviral drugs or new treatment regimens, but on the access to HIV medication and linkage to healthcare. In Madrid, which has a public universal healthcare system; coverage on public health diseases, including HIV infection, is mandatory. Therefore, medical care and treatment for those diseases are entirely free [ 6 ]. The city also has a wide network of hospitals and clinics. However, factors such as healthcare system saturation, immigration, social exclusion, and stigma have been identified as barriers to accessing healthcare centers for PLHIV and individuals at risk of infection [ 7 ]. In 2022, Infectious Diseases (ID) Unit in Gregorio Marañón University Hospital (HGUGM) and non-governmental organization (NGO) COGAM developed a project entirely implemented in the community, meaning outside the hospital environment; aimed at the recruitment and direct referral to the hospital with the objective to reinforce linkage to care in PLHIV. Here we present the results obtained and the impact of this project on the activity of the HIV Ward compared to previous years. MATERIALS AND METHODS The HGUGM is a tertiary hospital that is part of the public hospital network in Madrid. Users can access either from the EmergencyWard, or from Primary Care, or from referral from other public healthcare centers. COGAM, on the other hand, is a non-profit NGO focused on serving the LGBT + community in Madrid. At its headquarters, they carry out rapid diagnosis tests for HIV and HCV infection anonymously and free of charge. In 2022, with the aim of facilitating and reinforcing access to the healthcare system for PLHIV and population at risk; both institutions, HGUGM and COGAM, carried out an informative, divulgate HIV-project but also screening, recruitment, and referral-to-care program whose geographical spot of intervention was extrahospitallary, thus took place in the community. For this purpose, usual activity of COGAM was increased through informative sessions at its headquarters open to the public; intensification of their activity on social networks; and increasing the number of kits available for rapid diagnosis. At the same time, a circuit for direct and rapid referral to the ID Unit of the HGUGM was established. To analyze the results of this intervention in PLHIV and also the impact it had on the ID Unit, a retrospective observational study was conducted of all people with HIV infection who had initiated follow-up and treatment for their infection at the HGUGM between 1st January 2019 to 31st December 2022. We selected this time period to include both the intervention time and the previous period showing ID Unit usual activity, which we extended to reach the pre-pandemic year, to avoid the potential effect COVID could have had on the study population. We included patients newly diagnosed who had not yet received ART and patients with previous diagnose of HIV infection performed in other centers who attended the HGUGM for continuity of care. For all of them and through the information provided in the hospital's electronic medical records, epidemiological, social, clinical, and immunovirological variables were collected. After performing descriptive analysis, we compared the characteristics of those patients referred from NGOs with those patients who came through conventional referral channels that are entirely from and within the healthcare system. The study was conducted in accordance with the Declaration of Helsinki and Istanbul and was approved by the ethics committee of the Hospital General Universitario Gregorio Marañón, which waived informed consent for the collection of clinical data (Code: MICRO.HGUGM.2022-026). All the processes satisfied the local data confidentiality requirements. Statistical analysis: The results of continuous variables are presented as median and interquartile range (percentile 25; percentile 75). For categorical variables, results are shown in frequencies and percentages. Normality analysis was studied from frequency histograms and with the Kolmogorov-Smirnov test. To study the differences in means between the two groups, parametric tests (Student's t-test or ANOVA) or non-parametric tests (Mann-Whitney or Kruskal-Wallis) were used, choosing the most appropriate one in each case based on the normality of the data and the total number of patients in each group. The association between qualitative variables was studied using Pearson's chi-square test or Fisher's exact test. To study the predictive factors of loss to follow-up, Kaplan-Meier curves and Cox regression were utilized. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 25.0. (IBM Corp., Armonk, NY). Bilateral tests were employed, and results with a p-value < 0.05 were considered statistically significant. RESULTS Between1st January 2019 to 31st December 2022, the ID Unit of HGUGM received 500 new patients diagnosed with HIV infection. Among these, 203 were newly diagnosed cases (53 in 2019, 38 in 2020, 49 in 2021, 60 in 2022) and 297 were patients referred from other healthcare centers to HGUGM for continuity of HIV care and treatment (62 in 2019, 45 in 2020, 53 in 2021, 135 in 2022). 86 of all these patients were referred from an NGO, of which 21 were newly diagnosed with HIV infection and 67 were patients with previously known infection. In 2019, no patients were referred from an NGO, in 2020 only one for continuity of care for a known HIV infection, and in 2021 seven patients, three of whom were newly diagnosed with the infection. In 2022, following the direct referral program established with COGAM, the number increased to 78 patients with HIV infection referred from NGOs: 17 were naive cases and the rest were previously diagnosed patients. Of the total 500 patients, their epidemiological, clinical and social characteristics are shown in Table 1 . Table 1 Epidemiological, clinical and social characteristics New diagnosis (n = 203) Follow up (n = 297) Overall (n = 500) NGO (n = 21) No NGO (n = 182) p NGO (n = 67) No NGO (n = 230) p NGO (n = 88) No NGO (n = 412) p Age (years) 30 (25–38) 36 (30–45) 0.007 30 (28–36) 37 (30–49) 0.0000 30 (28–36) 37 (30–47) 0.0000 Sex: • Men • Women • Trans women 20 (95%) 0 1 (5%) 154 (85) 21 (11%) 7 (4%) 0.1878 0.1002 0.8382 63 (94%) 0 4 (6%) 191 (83%) 29 (13%) 10 (4%) 0.0245 0.0022 0.5814 83 (94%) 0 5(6%) 345 (84%) 50 (12%) 17 (4%) 0.0103 0.0006 0.5184 Country of origin: • Spain • Rest of Europe • Venezuela • Colombia • Peru • Rest of latinamerica • Morroco • Subsaharan Africa • Others 3 (14%) 0 7 (33%) 4 (19%) 3 (15%) 4 (19%) 0 0 0 81 (44%) 5 (3%) 24 (13%) 9 (5%) 14 (8%) 32 (18%) 10 (5%) 4 (2%) 3 (2%) 0.0078 0.4418 0.0151 0.0124 0.3017 0.8678 0.2706 0.4926 0.5534 0 2 (3%) 18 (27%) 26 (39%) 7 (10%) 13 (19%) 0 0 1 (2%) 73 (32%) 15 (6%) 38 (16%) 24 (10%) 18 (8%) 50 (22%) 2 (1%) 6 (3%) 4 (2%) 0.0000 0.2728 0.0568 0.0000 0.4964 0.6806 0.4438 0.1817 0.8902 3 (3%) 2 (2%) 25(29%) 30 (34%) 10 (12%) 17 (19%) 0 0 1 (1%) 154 (37%) 20 (5%) 62 (15%) 33 (8%) 32 (8%) 82 (20%) 12 (3%) 10 (2%) 7 (2%) 0.0000 0.2838 0.0027 0.0000 0.2695 0.9006 0.1051 0.1399 0.7026 Time in Spain (months) 46 (13–118) 9 (7–15) 0.003 7 (2–55) 3 (1–7) 0.0000 5 (1–9) 28 (4–96) 0.0000 Initial Healthcare coverage • No 10 (48%) 14 (8%) 0.0000 59 (88%) 48 (21&) 0.0000 69 (78%) 62 (15%) 0.0000 Final Healthcare coverage • NO 6 (29%) 8 (4%) 0.0000 17 (25%) 19 (8%) 0.0002 23 (26%) 27 (7%) 0.000 REFERRED FROM Emergency room Other hospital ward Primary Care STI Clinic Other hospital in Madrid Other hospital outside Madrid Other/unkown 40 (22%) 52 (29%) 48 (26%) 16 (9%) 6 (3%) 0 20 (11%) 31 (14%) 22 (10%) 47 (20%) 9 (4%) 26 (11%) 26 (11%) 69 (30%) 71 (17%) 74 (18%) 95 (23%) 25 (6%) 32 (8%) 26 (6%) 89 (22%) Time of HIV Infection (years) 5 (2–8) 7 (4–12) 0.001 Risk group MSM Hetero IVDU MSM/IVDU Other/unknown 21 (100%) 133 (76%) 34 (20%) 3 (2%) 4 (2%) 0.0123 0.0258 0.5442 0.4827 65 (98.5%) 1 (1.5%) 166 (75%) 32 (14%) 21 (9%) 2 (1%) 2 (1%) 0.0000 0.0040 0.0096 0.4401 0.4401 86 (99% 1 (1%) 299 (75%) 66 (17%) 24 (6%) 6 (1.5%) 2 (0.5%) 0.0000 0.0002 0.0187 0.2486 0.5071 Prior AIDS condition 1 (5%) 28 (15%) 0.1878 3 (5%) 28 (12%) 0.0698 4 (5%) 56 (14%) 0.0178 Basal CD4 count 394 (256–537) 358 (195–555) 0.571 665 (505–842) 624 (402–879) 0.380 Basal Viral load -log 4.5 (4–5) 5 (4–6) 0.080 Detectable viral load for ART interruption at recruitment 10 (15%) 54 (24%) 0.0894 Delay on ART initiation (days) 6 (2–21) 14 (7–34) 0.054 AIDS condition at recruitment 1 (33%) 19 (14%) 0.3486 2 (33%) 7 (5%) 0.0029 3 (33%) 26 (9%) 0.0159 STD basal 9 (43%) 52 (29%) 0.1819 13 (19%) 44 (19%) 0.9725 22 (25%) 96 (23%) 0.7510 Quantiferon + 3 (15%) 16 (10%) 0.4545 8 (13%) 23 (12%) 0.8897 11 (13%) 39 (11%) 0.5392 Active TB 1 (5%) 3 (2%) 0.3337 1 (1.5%) 2 (1%) 0.6551 2 (2%) 5 (1%) 0.4433 No HIV related diseases: Cardiovascular Oncological Hypertension Diabetes Mellitus Dyslipidemia Nephropathy Respiratory Disease Liver Disease 0 0 1 (5%) 0 0 0 0 0 3 (2%) 6 (3%) 9 (5%) 4 (2%) 4 (2%) 2 (1%) 4 (2%) 5 (3%) 0.5522 0.3970 0.9664 0.4914 0.4914 0.6283 0.4902 0.4406 0 1 (1.5%) 0 0 6 (9%) 0 1 (1.5%) 0 7 (3%) 6 (3%) 17 (8%) 8 (4%) 28 (12%) 2 (1%) 5 (2%) 27 (12%) 0.1466 0.5902 0.0213 0.1201 0.4536 0.4418 0.7210 0.0031 0 1 (1%) 1 (1%) 0 6 (7% 0 1 (1%) 0 10 (2%) 12 (3%) 26 (6%) 12 (3%) 32 (8%) 4 (1%) 9 (2%) 32 (8%)) 0.1384 0.3378 0.0500 0.1038 0.7474 0.3516 0.5174 0.0067 STD while follow-up 4 (19%) 34 (19%) 0.9763 11 (16%) 39 (17%) 0.8614 15 (17%) 73 (18%) 0.7977 Closure: 1: active follow-up 2: move to other region 3: move to other country 4: return to original country 5: lost of follow-up 6: jail 7: death 8. change of hospital in Madrid 16 (76%) 1 (5%) 1 (5%) 0 2 (9%) 0 0 1 (5%) 156 (86%) 9 (5%) 3 (1.5%) 0 8 (4%) 1 (0.5%) 2 (1%) 3 (2%) 0.2506 0.9707 0.3310 0.3039 0.7335 0.6293 0.3310 50 (75%) 3 (5%) 0 0 12 (18%) 0 0 2 (3%) 179 (78%) 19 (8%) 1 (0.5%) 3 (1%) 21 (9%) 1 (0.5%) 0 6 (3%) 0.5834 0.2981 0.5888 0.3474 0.0442 0.5888 0 0.8670 335 (82%) 28 (7%) 4 (1%) 3 (1%) 29 (7%) 2 (0.5%) 2 (0.5%) 9 (2%) 66 (75%) 4 (5%) 1 (1%) 0 14 (16%) 0 0 3 (3%) 0.1775 0.4336 0.8874 0.4220 0.0071 0.5125 0.5125 0.4956 At the end of the study, there were 43 (9%) patients who were lost to follow-up (LFU) from the total included, of which 14 (16%) came from NGOs. 8% (401) of the overall patients in the study maintained active follow-up at the end of the study period; and 75% (66) of those coming from NGOs. When analyzing other causes to discontinue follow-up in our clinic apart from LFU, such as transfer to another hospital, move to other Community in Spain, or return to country of origin, no differences were found between patients from the NGO compared to those who had accessed our ID service through other means. A multivariate analysis of factors associated with LFU was conducted using Cox regression and adjusting for country of origin other than Spain; NGO origin; time in Spain (less than 1 year, between 1 and 10 years, and more than 10 years); IV drug user risk group, CDC stage C; and health coverage at the end of the study. Only the absence of health coverage at the time of study closure reached statistical significance as an independent factor for LFU (HR 5.19, CI 2.76–9.47). Other factors such as coming from an NGO (HR 1.94, CI 0.99–3.89) or being from a country other than Spain (HR 3.08, CI 0.93–10.16) nearly reached significance. It is important to note that the number of losses in the overall study is small, which limits this analysis. Figure 1 . For naive patients, establishing a direct referral pathway to the hospital from the NGO helped shorten the time from HIV diagnosis to the initiation of antiretroviral therapy (ART): 6 days for naive patients from an NGO, compared to 14 days for other newly diagnosed individuals ( p = 0.054). Hence, we aimed to analyze whether early initiation of ART was associated with a higher LFU. For this, a multivariate analysis using Cox regression for LFU in the naive patients of our study was conducted, adjusted for: delay in the start of ART (less than 7 days, between 7 and 14 days, and more than 14 days); country of origin other than Spain; NGO origin; time in Spain (less than 1 year, between 1 and 10 years, and more than 10 years); CDC stage C; and health coverage at the end of the study. None of these factors showed statistical significance as predictors of loss to follow-up, although the number of losses to follow-up was very small, limiting the power of the analysis. Figure 2 . DISCUSSION The project presented demonstrates that the collaboration of health institutions with NGOs in conducting community interventions is an essential strategy for linking PLHIV to the healthcare system. In the epidemiological control of HIV infection, the challenge is to provide access to ART for every infected patient. Globally, obtaining these drugs requires visiting healthcare institutions, typically hospitals, where the medication is dispensed. In this process, PLHIV may encounter multiple barriers that ultimately impede achieving the UNAIDS targets for 2030 “95-95-95”. These barriers vary by individual according to his geographic area of residence and the healthcare setting he is in; but globally the main issues are stigma and difficulty accessing healthcare facilities to obtain medication [ 7 – 10 ]. These two aspects also have an impact on the psychological sphere, worsening the negative health and wellbeing effects of the infection [ 11 ]. Regarding stigma, often stigma inherent to HIV infection overlaps with that linked to certain groups such as men who have sex with men, transgender people, non-Caucasian races, or migrants [ 12 – 15 ]. Concerning accessibility to healthcare, while ART is available worldwide, there are obstacles such as the physical distance from a patient's residence to healthcare centers; or the lack of health coverage that prevents the admission on healthcare system. Addressing all these issues is where healthcare institutions have many limitations, and where direct collaboration with NGOs can be of great help. In public health, for the prevention in transmission of infections that are a threat to the community, collaboration between governments and NGOs has led to improvements in epidemiological control [ 16 – 19 ]. Regarding HIV, NGOs have always played a crucial role in preventing infection and in accessing treatment for infected individuals, serving as a link with socially excluded groups such as sex workers, drug addicts, migrants, or the homosexual population [ 20 – 21 ]. Concerning PLHIV and individuals at risk of infection, in countries where stigma towards the community of men who have sex with men has been identified as the main obstacle to accessing HIV diagnosis, such as China [ 22 ], India [ 23 ], or Cameroon[ 24 – 25 ], community strategies have been implemented to facilitate access to the healthcare system and antiretroviral medication. In Western countries where health standards and legislation should be favorable to ensuring therapeutic coverage for PLHIV, there are still infected individuals who do not undergo treatment. The migrant population is particularly vulnerable [ 26 ], representing over 50% of new HIV infection diagnoses in Spain [ 27 ], most of them late presenters [ 28 ]. Therefore, screening and counseling strategies are necessary in this population [ 29 ]. Despite optimizing resources from institutions, it is imperative to intervene directly in the community so collaboration with NGOs is essential. In Catalonia (Spain), there is already close collaboration with HIV-related NGOs, and currently, 30% of new HIV infection diagnoses in this region are made in these organizations [ 30 – 31 ]. Our work is conducted in Madrid, where coverage for patients with public health diseases, including HIV infection, is universal and free. However, the program presented in this work, involving direct collaboration with NGOs for community intervention, has allowed us to reach a population that does not enter healthcare system through conventional channels, and to whom we were not previously providing coverage, posing a threat to the epidemiological control of HIV pandemic. In our analysis, we found distinctive characteristics of these individuals compared to the rest of PLHIV. They were, essentially, men or transgender women infected by sexual transmission, predominantly newly arrived migrants to Spain in irregular administrative situation. Almost all came from Latin American countries. Overall, no differences were observed in terms of HIV clinical manifestations, immunovirological status, or presence of other comorbidities. We analyzed sexually transmitted infections (STIs) that were registered in clinical records by the time patients were first seen in the hospital and also throughout the follow-up in our center. We emphasize that the main objective of this study was not the analysis of STIs and that the direct collaboration project with the NGO focused on HIV infection, without any specific diagnostic or therapeutic strategy for STIs. Therefore, we believe that the STIs incidence found in our study may be underestimated. Despite this, that incidence was remarkable in both groups as 17% of PLHIV from the total individuals included in the study presented some type of STI during follow-up in our center. Simultaneously, the establishment of a direct referral pathway has allowed prompt evaluation of these HIV patients in the hospital, streamlining the initiation of ART in naive patients. Strategies for rapid initiation of ART have been questioned for their potential limitations in promoting linkage to healthcare system for PLHIV, particularly for vulnerable populations [ 32 – 34 ]. However, some studies conducted in low-income countries seem to indicate the opposite [ 35 ], as well as publications in vulnerable populations in the United States [ 36 – 37 ]. In our work, in naive patients, we did not find differences in the risk of LFU in those who initiated ART in the first 7 days compared to those initiated in the first 14 days or later, although a limitation of our analysis is that the number of losses was very low. On the other hand, our community interventional program for diagnosis and referral to healthcare in PLHIV did not find a favorable impact on early diagnosis of HIV infection, as the median CD4 count at diagnosis in naïve patients was similar in both groups, derived and not derived from NGOs, although that median was above 350 cells/microliter. In the presented collaboration project between HGUGM and the NGO COGAM for the direct referral of PLHIV to the hospital, social workers from both institutions were integrated. They provided counseling and administrative assistance to migrant population, thereby achieving integration into the healthcare system for most of the included patients. Thus, while patients from NGOs compared to those accessing the healthcare system through other channels were significatively higher on administrative exclusion at the start and at the end of the study, the proportion of patients from NGOs in social exclusion decreased from 78% upon arrival at the hospital to 26% at the end of the study due to the work of the social workers. This had a very favorable impact on treatment adherence and linkage to care, as reflected in administrative exclusion being the only factor related to LFU in our analysis. The legal absence of healthcare coverage had already been identified in previous studies as the main barrier to access to ART in Europe [ 38 – 40 ]. CONCLUSIONS Direct collaboration with NGOs to reinforce the diagnosis, medical follow-up, and treatment adherence of people living with HIV infection allows for direct intervention in the community, accessing a group of patients who do not use standardized referral channels. These PLHIV are primarily migrant homosexual men from South American countries, newly arrived in Spain and still in administrative exclusion. Despite the availability of ART in Spain, this situation of administrative exclusion is the main barrier to accessing the healthcare system and the main factor associated with loss to follow-up in PLHIV. Collaboration with NGOs within a multidisciplinary team including doctors, nurses, and social workers facilitates the administrative incorporation into healthcare systems of individuals in exclusion. Furthermore, establishing a direct referral pathway to Infectious Diseases Services in newly diagnosed naive HIV patients shortens the time to initiate ART without impacting treatment adherence or retention in the healthcare system. Abbreviations NGO: non-governmental organization ART: antiretroviral treatment HIV: human immunodeficiency virus PLHIV: people living with HIV LGBT+: lesbian, gays, bisexual, transgender ID: Infectious Diseases HGUGM: Gregorio Marañón University Hospital Declarations ACKNOWLEDGEMESTS: Gilead Grants, project number:14855 AUTHOR´S CONTRIBUTIONS: Teresa Aldamiz-Echevarria (TAE), Chiara Fanciulli (CF), Mónica López (ML), Leire Pérez (LP), Francisco Tejerina (FT), David Sánchez (DS), Blanca Lodeiro (BL), Juan Carlos López (JCL), Juan Brerenguer (JB), Cristina Diez (CD) contributed to the study development, data collection, data analysis and redaction of the manuscript Jose Maria Bellón (JMB) contributed in the statistical analysis Maria Ferris (MF), Mario Blazquez (MB), Almudena Calvo (AC), Mario Domene (MD), Oswaldo Vegas (OV), Carmen Rodriguez (CR) contributed to the study development Patricia Muñoz (PM), Paloma Gijón (PG), Pedro Montilla (PM), Elena Bermúdez (EB), Maricela Valerio (MV), Roberto Alonso (RA), Belen Padrilla (BP), Cristina Ventimilla (CV) contributed to the study development and redaction of the manuscript Availability of data and materials: Data is provided within the manuscript Ethics approval and consent to participate: The study has been approved by the ethics committee of the Gregorio Marañón Hospital (Code: MICRO.HGUGM.2022-026). Consent for publication: all authors agree for publication Competing interests: the authors have no competitive interests Funding. This project received grant from Gilead Grants (project number:14855). References Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JH, Godbole SV, Chariyalertsak S, Santos BR, Mayer KH, Hoffman IF, Eshleman SH, Piwowar-Manning E, Cottle L, Zhang XC, Makhema J, Mills LA, Panchia R, Faesen S, Eron J, Gallant J, Havlir D, Swindells S, Elharrar V, Burns D, Taha TE, Nielsen-Saines K, Celentano DD, Essex M, Hudelson SE, Redd AD, Fleming TR; HPTN 052 Study Team. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med. 2016 Sep 1;375(9):830-9. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Degen O, Corbelli GM, Estrada V, Geretti AM, Beloukas A, Raben D, Coll P, Antinori A, Nwokolo N, Rieger A, Prins JM, Blaxhult A, Weber R, Van Eeden A, Brockmeyer NH, Clarke A, Del Romero Guerrero J, Raffi F, Bogner JR, Wandeler G, Gerstoft J, Gutiérrez F, Brinkman K, Kitchen M, Ostergaard L, Leon A, Ristola M, Jessen H, Stellbrink HJ, Phillips AN, Lundgren J; PARTNER Study Group. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet. 2019 Jun 15;393(10189):2428-2438. Lundgren JD, Babiker AG, Sharma S, Grund B, Phillips AN, Matthews G, Kan VL, Aagaard B, Abo I, Alston B, Arenas-Pinto A, Avihingsanon A, Badal-Faesen S, Brites C, Carey C, Casseb J, Clarke A, Collins S, Corbelli GM, Dao S, Denning ET, Emery S, Eriobu N, Florence E, Furrer H, Fätkenheuer G, Gerstoft J, Gisslén M, Goodall K, Henry K, Horban A, Hoy J, Hudson F, Azwa RISR, Kedem E, Kelleher A, Kityo C, Klingman K, Rosa A, Leturque N, Lifson AR, Losso M, Lutaakome J, Madero JS, Mallon P, Mansinho K, Filali KME, Molina JM, Murray DD, Nagalingeswaran K, Nozza S, Ormaasen V, Paredes R, Peireira LC, Pillay S, Polizzotto MN, Raben D, Rieger A, Sanchez A, Schechter M, Sedlacek D, Staub T, Touloumi G, Turner M, Madruga JV, Vjecha M, Wolff M, Wood R, Zilmer K, Lane HC, Neaton JD; INSIGHT Strategic Timing of AntiRetroviral Treatment (START) Study Group. Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection. NEJM Evid. 2023 Mar;2(3):10.1056/evidoa2200302. https://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf (19 May 2024, date last accessed). Frescura L, Godfrey-Faussett P, Feizzadeh A A, El-Sadr W, Syarif O, Ghys PD; on and behalf of the 2025 testing treatment target Working Group. Achieving the 95 95 95 targets for all: A pathway to ending AIDS. PLoS One. 2022 Aug 4;17(8):e0272405. Ministerio de Sanidad, Servicios Sociales e Igualdad. Boletín Oficial del Estado— Legislación Consolidada, 2012. Available at: http://www.msssi.gob.es/profesionales/ prestacionesSanitarias/CarteraDeServicios/docs/RDL_16_2012.pdf (19 May 2024, date last accessed). Ndumbi P, Del Romero J, Pulido F, Velasco Arribas M, Dronda F, Blanco Ramos JR, García de Olalla P, Ocaña I, Belda-Ibañez J, Del Amo J, Álvarez-Del Arco D; aMASE Research Group. Barriers to health care services for migrants living with HIV in Spain. Eur J Public Health. 2018 Jun 1;28(3):451-457. Latkin C, Weeks MR, Glasman L, Galletly C, Albarracin D. A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS Behav. 2010 Dec;14(Suppl 2):222-38. Auerbach JD, Parkhurst JO, Cáceres CF. Addressing social drivers of HIV/AIDS for the long-term response: conceptual and methodological considerations. Glob Public Health. 2011;6 Suppl 3:S293-309. Arora AK, Ortiz-Paredes D, Engler K, Lessard D, Mate KKV, Rodriguez-Cruz A, Kronfli N, Vedel I, Cox J, Quesnel-Vallée A, Lebouché B. Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review. AIDS Patient Care STDS. 2021 Aug;35(8):288-307. Qiao S, Li X, Stanton B. Social support and HIV-related risk behaviors: a systematic review of the global literature. AIDS Behav. 2014 Feb;18(2):419-41. Flowers P, Davis M, Hart G, et al. Diagnosis and stigma and identity amongst HIV positive Black Africans living in the UK. Psychol Health 2006;21:109–22. Boyd AE, Murad S, O’shea S, et al. Ethnic differences in stage of presentation of adults newly diagnosed with HIV-1 infection in south London. HIV Med 2005;6: 59–65. Scheppers E, van Dongen E, Dekker J, et al. Potential barriers to the use of health services among ethnic minorities: a review. Family Practice 2006; 23:325–48. Deblonde J, De Koker P, Hamers FF, et al. Barriers to HIV testing in Europe: a systematic review. Eur J Pub Health 2010; 20:422–32 Sanadgol A, Doshmangir L, Majdzadeh R, Gordeev VS. Engagement of non-governmental organisations in moving towards universal health coverage: a scoping review. Global Health. 2021 Nov 16;17(1):129. Rajabi M, Ebrahimi P, Aryankhesal A. Collaboration between the government and nongovernmental organizations in providing health-care services: A systematic review of challenges. J Educ Health Promot. 2021 Jun 30;10:242. Zafar Ullah AN, Newell JN, Ahmed JU, Hyder MK, Islam A. Government-NGO collaboration: the case of tuberculosis control in Bangladesh. Health Policy Plan. 2006 Mar;21(2):143-55. Rangan SG, Juvekar SK, Rasalpurkar SB, Morankar SN, Joshi AN, Porter JD. Tuberculosis control in rural India: lessons from public-private collaboration. Int J Tuberc Lung Dis. 2004 May;8(5):552-9. Kelly JA, Somlai AM, Benotsch EG, Amirkhanian YA, Fernandez MI, Stevenson LY, Sitzler CA, McAuliffe TL, Brown KD, Opgenorth KM. Programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. AIDS Care. 2006; 18 :12–21. Sehgal PN. Prevention and control of AIDS: the role of NGOs. Health Millions. 1991; 17 :31–33. Chow EP, Lau JT, Zhuang X, Zhang X, Wang Y, Zhang L. HIV prevalence trends, risky behaviours, and governmental and community responses to the epidemic among men who have sex with men in China. Biomed Res Int. 2014;2014:607261. Bhutada K, Chakrapani V, Gulfam FR, Ross J, Golub SA, Safren SA, Prasad R, Patel VV. Pathways Between Intersectional Stigma and HIV Treatment Engagement Among Men Who Have Sex with Men (MSM) in India. J Int Assoc Provid AIDS Care. 2023 Jan-Dec;22:23259582231199398. Holland CE, Papworth E, Billong SC, Kassegne S, Petitbon F, Mondoleba V, Moukam LV, Macauley I, Eyene Ntsama SP, Yomb YR, Eloundou J, Mananga F, Tamoufe U, Baral SD. Access to HIV Services at Non-Governmental and Community-Based Organizations among Men Who Have Sex with Men (MSM) in Cameroon: An Integrated Biological and Behavioral Surveillance Analysis. PLoS One. 2015 Apr 23;10(4):e0122881. Park JN, Papworth E, Billong SC, Elat JB, Kassegne S, Grosso A, Moukam L, Macauley I, Yomb YR, Mondoleba V, Eloundou J, LeBreton M, Ketende SC, Baral S. Correlates of prior HIV testing among men who have sex with men in Cameroon: a cross-sectional analysis. BMC Public Health. 2014 Nov 25;14:1220. Deblonde, J., Sasse, A., Del Amo, J. et al. Restricted access to antiretroviral treatment for undocumented migrants: a bottle neck to control the HIV epidemic in the EU/EEA. BMC Public Health 15 , 1228 (2015). Área de Vigilancia de VIH y Comportamientos de Riesgo. Vigilancia Epidemiológica del VIH y sida en España: Sistema de Información sobre Nuevos Diagnósticos de VIH y Registro Nacional de Casos de Sida. Plan Nacional Sobre el SIDA, 2016. Available at: http://www.mscbs.es/ciudadanos/enfLesiones/enfTransmisibles/sida/vigilancia/docs/Informe_VIH_SIDA_2023.pdf Monge S, Alejos B, Dronda F, Del Romero J, Iribarren JA, Pulido F, Rubio R, Miró JM, Gutierrez F, Del Amo J; CoRIS. Inequalities in HIV disease management and progression in migrants from Latin America and sub-Saharan Africa living in Spain. HIV Med. 2013 May;14(5):273-83. Alvarez-del Arco D, Monge S, Azcoaga A, et al. HIV testing and counselling for migrant populations living in high-income countries: a systematic review. Eur J Pub Health 2013; 23:1039–45. Berenguera A, Pujol-Ribera E, Violan C, Romaguera A, Mansilla R, Giménez A, Ascaso C, Almeda J. Core indicators evaluation of effectiveness of HIV-AIDS preventive-control programmes carried out by nongovernmental organizations. A mixed method study. BMC Health Serv Res. 2011 Jul 28;11:176. Carta al director: Berenguera A, Almeda J, Violan C, Pujol-Ribera E. Percepción del riesgo de infección por VIH-SIDA de los usuarios de las organizaciones no gubernamentales que trabajan en la prevención-control del VIH-SIDA en Catalunya [Perception of the risk of HIV-AIDS infection of users by Non-Governmental Organisations (ONGs) who work in prevention-control of HIV-AIDS in Catalonia]. Aten Primaria. 2012 May;44(5):293-5. Spanish. Ford N, Migone C, Calmy A, Kerschberger B, Kanters S, Nsanzimana S, Mills EJ, Meintjes G, Vitoria M, Doherty M, Shubber Z. Benefits and risks of rapid initiation of antiretroviral therapy. AIDS. 2018 Jan 2;32(1):17-23. Cuzin L, Cotte L, Delpierre C, Allavena C, Valantin MA, Rey D, Delobel P, Pugliese P, Raffi F, Cabié A; Dat’AIDS Study group. Too fast to stay on track? Shorter time to first anti-retroviral regimen is not associated with better retention in care in the French Dat'AIDS cohort. PLoS One. 2019 Sep 6;14(9):e0222067. Mbatia RJ, Mtisi EL, Ismail A, Henjewele CV, Moshi SJ, Christopher AK, Nsanzugwanko NW, Bukuku AG, Msimbe RA, Kirato AR, Nyabukene FS, Mmari EJ, Rwebembera AA, Masanja BN, Kailembo A, Matiko EJ. Interruptions in treatment among adults on anti-retroviral therapy before and after test-and-treat policy in Tanzania. PLoS One. 2023 Nov 15;18(11):e0292740. Koenig SP, Dorvil N, Dévieux JG, Hedt-Gauthier BL, Riviere C, Faustin M, Lavoile K, Perodin C, Apollon A, Duverger L, McNairy ML, Hennessey KA, Souroutzidis A, Cremieux PY, Severe P, Pape JW. Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial. PLoS Med. 2017 Jul 25;14(7):e1002357. Coffey S, Bacchetti P, Sachdev D, Bacon O, Jones D, Ospina-Norvell C, Torres S, Lynch E, Camp C, Mercer-Slomoff R, Lee S, Christopoulos K, Pilcher C, Hsu L, Jin C, Scheer S, Havlir D, Gandhi M. RAPID antiretroviral therapy: high virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population. AIDS. 2019 Apr 1;33(5):825-832. Colasanti J, Sumitani J, Mehta CC, et al. Implementation of a rapid entry program decreases time to viral suppression among vulnerable persons living with HIV in the Southern United States. Open Forum Infect Dis . 2018;5(6):ofy104. Suess A, Ruiz Perez I, Ruiz Azarola A, March Cerda JC. The right of access to health care for undocumented migrants: a revision of comparative analysis in the European context. Eur J Public Health 2014; 24:712–20. Vignier N, Dray Spira R, Pannetier J, Ravalihasy A, Gosselin A, Lert F, Lydie N, Bouchaud O, Desgrees Du Lou A, Chauvin P; PARCOURS Study Group. Refusal to provide healthcare to sub-Saharan migrants in France: a comparison according to their HIV and HBV status. Eur J Public Health. 2018 Oct 1;28(5):904-910. Nöstlinger C, Cosaert T, Landeghem EV, Vanhamel J, Jones G, Zenner D, Jacobi J, Noori T, Pharris A, Smith A, Hayes R, Val E, Waagensen E, Vovc E, Sehgal S, Laga M, Van Renterghem H. HIV among migrants in precarious circumstances in the EU and European Economic Area. Lancet HIV. 2022 Jun;9(6):e428-e437. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Jan, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 16 Dec, 2024 Reviews received at journal 09 Nov, 2024 Reviewers agreed at journal 08 Nov, 2024 Reviews received at journal 27 Oct, 2024 Reviewers agreed at journal 25 Oct, 2024 Reviewers agreed at journal 23 Oct, 2024 Reviewers invited by journal 30 Aug, 2024 Editor assigned by journal 30 Aug, 2024 Editor invited by journal 20 Aug, 2024 Submission checks completed at journal 19 Aug, 2024 First submitted to journal 05 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4862637","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":354326411,"identity":"7e90fc4b-d3d5-4e58-a81c-1753c90aef5f","order_by":0,"name":"Teresa Aldámiz-Echevarria","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYPACC8YGBiD6wMCQQFAtD4SSAGthnEGiFgYGZh5itNiz9z58+KNGQrZ/2uHmz7Ztdnn87A2MD3/gs4XnuLExzzEJ4xm3ExuMc9uSiyV7DjAb8+DTIpHGJs3AJpHYANSSnNvGnLjhRgJQBJ8W+WfsP3/8k0icD9Ry2LKtHqQFKILXFjY2Bt42icQNtxMbmxnbDoNtYcDrsDNpzNK8fRLGG28nNjP2nDueOLPnYLM0Pi3s7ccYP/74ZiM773b64w8/yqoT+9mbD37E5zBUwMgGJhuI1gAEf0hRPApGwSgYBSMFAABTGU8/CxtLZAAAAABJRU5ErkJggg==","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":true,"prefix":"","firstName":"Teresa","middleName":"","lastName":"Aldámiz-Echevarria","suffix":""},{"id":354326412,"identity":"12f49cec-2030-43a6-8f19-c284b48c6dec","order_by":1,"name":"Chiara Fanciulli","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Chiara","middleName":"","lastName":"Fanciulli","suffix":""},{"id":354326413,"identity":"448037c9-4a4b-4926-8228-30052bc945b9","order_by":2,"name":"Monica Lopez","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Monica","middleName":"","lastName":"Lopez","suffix":""},{"id":354326414,"identity":"535123ab-9c29-4b13-abae-8a9e86ad9c24","order_by":3,"name":"Leire Perez","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Leire","middleName":"","lastName":"Perez","suffix":""},{"id":354326415,"identity":"8f47ae23-5ed4-4186-a09d-e590537181be","order_by":4,"name":"Francisco Tejerina","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Francisco","middleName":"","lastName":"Tejerina","suffix":""},{"id":354326416,"identity":"1f78dc95-1fba-4a5b-9d2b-31b1794cf8a6","order_by":5,"name":"David Sanchez","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Sanchez","suffix":""},{"id":354326417,"identity":"1b532cfe-fb1f-4ab4-92be-d88acd4b3de1","order_by":6,"name":"Blanca Lodeiros","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Blanca","middleName":"","lastName":"Lodeiros","suffix":""},{"id":354326418,"identity":"97c1127b-c159-4c70-98f8-807575719d2c","order_by":7,"name":"Juan Carlos Lopez","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Carlos","lastName":"Lopez","suffix":""},{"id":354326419,"identity":"5826c2b2-b999-4ba8-9561-889ed73d85bb","order_by":8,"name":"Juan Berenguer","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"Berenguer","suffix":""},{"id":354326420,"identity":"32e0a7a9-abf6-478b-a359-4655b922afc6","order_by":9,"name":"Jose Maria Bellon","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Jose","middleName":"Maria","lastName":"Bellon","suffix":""},{"id":354326421,"identity":"036ee061-dd3f-4baa-b64b-5ecdf0dba02e","order_by":10,"name":"Maria Ferris","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Ferris","suffix":""},{"id":354326422,"identity":"67154767-599d-4b79-a508-bede631169bf","order_by":11,"name":"Mario Blazquez","email":"","orcid":"","institution":"Cogam, NGO, Madrid, Spain","correspondingAuthor":false,"prefix":"","firstName":"Mario","middleName":"","lastName":"Blazquez","suffix":""},{"id":354326423,"identity":"eaee9f1e-0a0b-44c0-a593-508c02b48c44","order_by":12,"name":"Almudena Calvo","email":"","orcid":"","institution":"Cogam, NGO, Madrid, Spain","correspondingAuthor":false,"prefix":"","firstName":"Almudena","middleName":"","lastName":"Calvo","suffix":""},{"id":354326424,"identity":"49e00caf-5a76-4b7d-a6f8-e950b04f9ccd","order_by":13,"name":"Mario Domene","email":"","orcid":"","institution":"Cogam, NGO, Madrid, Spain","correspondingAuthor":false,"prefix":"","firstName":"Mario","middleName":"","lastName":"Domene","suffix":""},{"id":354326425,"identity":"26be5165-bc61-4557-93c3-9bfda5c881c8","order_by":14,"name":"Oswaldo Vegas","email":"","orcid":"","institution":"Cogam, NGO, Madrid, Spain","correspondingAuthor":false,"prefix":"","firstName":"Oswaldo","middleName":"","lastName":"Vegas","suffix":""},{"id":354326426,"identity":"36ab430e-c330-4601-ab62-a11d6cd7ceec","order_by":15,"name":"Carmen Rodriguez","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Carmen","middleName":"","lastName":"Rodriguez","suffix":""},{"id":354326427,"identity":"829df41e-2a6a-466b-b5e1-161ce2bb11e9","order_by":16,"name":"Patricia Muñoz","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Patricia","middleName":"","lastName":"Muñoz","suffix":""},{"id":354326428,"identity":"d86318d7-2a8f-4d1f-a6db-62a72668b410","order_by":17,"name":"Paloma Gijon","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Paloma","middleName":"","lastName":"Gijon","suffix":""},{"id":354326429,"identity":"57b10adf-1b9e-4341-b0cf-b81f549c81fe","order_by":18,"name":"Pedro Montilla","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Pedro","middleName":"","lastName":"Montilla","suffix":""},{"id":354326430,"identity":"ca87313c-1a07-46f1-a8d1-a24270f8e66d","order_by":19,"name":"Elena Bermudez","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Elena","middleName":"","lastName":"Bermudez","suffix":""},{"id":354326431,"identity":"ffb39a61-8aa9-4e32-90a2-d18d0960c95e","order_by":20,"name":"Maricela Valerio","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Maricela","middleName":"","lastName":"Valerio","suffix":""},{"id":354326432,"identity":"4bc8d0de-dc7e-4f48-a113-e9c9b0e0dd87","order_by":21,"name":"Roberto Alonso","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Roberto","middleName":"","lastName":"Alonso","suffix":""},{"id":354326433,"identity":"9bcfc0d4-dd88-496a-8eaf-0ad53e69a5d7","order_by":22,"name":"Belen Padilla","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Belen","middleName":"","lastName":"Padilla","suffix":""},{"id":354326434,"identity":"d9e2aeda-dd9c-46eb-b8ac-e3d245a027ae","order_by":23,"name":"Cristina Ventimilla","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Cristina","middleName":"","lastName":"Ventimilla","suffix":""},{"id":354326435,"identity":"1f322f28-b50a-4392-9275-96d25d937f88","order_by":24,"name":"Cristina Diez","email":"","orcid":"","institution":"Hospital General Universitario Gregorio Marañón","correspondingAuthor":false,"prefix":"","firstName":"Cristina","middleName":"","lastName":"Diez","suffix":""}],"badges":[],"createdAt":"2024-08-05 14:18:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4862637/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4862637/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-86540-8","type":"published","date":"2025-01-28T15:57:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":64626482,"identity":"f09572f6-968e-4587-a558-aed4ed8c57ed","added_by":"auto","created_at":"2024-09-16 18:21:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23028,"visible":true,"origin":"","legend":"\u003cp\u003eMultivariable Cox regression analysis evaluating baseline factors associated with\u003c/p\u003e\n\u003cp\u003eLost of follow-up among all people living with HIV included in the study.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4862637/v1/bb6cd384b5d64f23b13743a7.png"},{"id":64626483,"identity":"17279dfc-071f-44d3-880c-72f443d58df7","added_by":"auto","created_at":"2024-09-16 18:21:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":25693,"visible":true,"origin":"","legend":"\u003cp\u003eMultivariable Cox regression analysis evaluating baseline factors associated with\u003c/p\u003e\n\u003cp\u003eLost of follow-up among all naive patients.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4862637/v1/c2da5875e5a5d0a49f6119b0.png"},{"id":75351462,"identity":"c39b50f3-e025-4eb0-859e-796c05cad092","added_by":"auto","created_at":"2025-02-03 16:11:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":822382,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4862637/v1/263871cd-de72-4203-895a-64f9427d0f73.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDirect collaboration between hospitals and NGOs, an essential tool to reinforce linkage to care in People living with HIV\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eHIV treatment regimens have progressively gained in effectiveness and tolerability over the decades. Therefore, nowadays and worldwide, virological failure normally isn\u0026rsquo;t due to inefficacy of antiretroviral treatment regimen but rather to lack of access to medication or poor therapeutic adherence. It has been demonstrated that undetectable viral load in people living with HIV (PLHIV) suppress viral transmission [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]; and moreover, it radically reduces mortality, both for HIV related diseases but also for non-HIV related conditions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. UNAIDS has set global targets to be achieved by 2030: 95% of HIV-infected patients will be diagnosed; 95% of those diagnosed will be on antiretroviral treatment; 95% of them will reach undetectable HIV viral load (95-95-95) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Achieving these goals will depend, therefore, not on the emergence of new antiretroviral drugs or new treatment regimens, but on the access to HIV medication and linkage to healthcare.\u003c/p\u003e \u003cp\u003eIn Madrid, which has a public universal healthcare system; coverage on public health diseases, including HIV infection, is mandatory. Therefore, medical care and treatment for those diseases are entirely free [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The city also has a wide network of hospitals and clinics. However, factors such as healthcare system saturation, immigration, social exclusion, and stigma have been identified as barriers to accessing healthcare centers for PLHIV and individuals at risk of infection [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In 2022, Infectious Diseases (ID) Unit in Gregorio Mara\u0026ntilde;\u0026oacute;n University Hospital (HGUGM) and non-governmental organization (NGO) COGAM developed a project entirely implemented in the community, meaning outside the hospital environment; aimed at the recruitment and direct referral to the hospital with the objective to reinforce linkage to care in PLHIV. Here we present the results obtained and the impact of this project on the activity of the HIV Ward compared to previous years.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThe HGUGM is a tertiary hospital that is part of the public hospital network in Madrid. Users can access either from the EmergencyWard, or from Primary Care, or from referral from other public healthcare centers.\u003c/p\u003e \u003cp\u003eCOGAM, on the other hand, is a non-profit NGO focused on serving the LGBT\u0026thinsp;+\u0026thinsp;community in Madrid. At its headquarters, they carry out rapid diagnosis tests for HIV and HCV infection anonymously and free of charge.\u003c/p\u003e \u003cp\u003e In 2022, with the aim of facilitating and reinforcing access to the healthcare system for PLHIV and population at risk; both institutions, HGUGM and COGAM, carried out an informative, divulgate HIV-project but also screening, recruitment, and referral-to-care program whose geographical spot of intervention was extrahospitallary, thus took place in the community. For this purpose, usual activity of COGAM was increased through informative sessions at its headquarters open to the public; intensification of their activity on social networks; and increasing the number of kits available for rapid diagnosis. At the same time, a circuit for direct and rapid referral to the ID Unit of the HGUGM was established.\u003c/p\u003e \u003cp\u003eTo analyze the results of this intervention in PLHIV and also the impact it had on the ID Unit, a retrospective observational study was conducted of all people with HIV infection who had initiated follow-up and treatment for their infection at the HGUGM between 1st January 2019 to 31st December 2022. We selected this time period to include both the intervention time and the previous period showing ID Unit usual activity, which we extended to reach the pre-pandemic year, to avoid the potential effect COVID could have had on the study population. We included patients newly diagnosed who had not yet received ART and patients with previous diagnose of HIV infection performed in other centers who attended the HGUGM for continuity of care.\u003c/p\u003e \u003cp\u003eFor all of them and through the information provided in the hospital's electronic medical records, epidemiological, social, clinical, and immunovirological variables were collected. After performing descriptive analysis, we compared the characteristics of those patients referred from NGOs with those patients who came through conventional referral channels that are entirely from and within the healthcare system.\u003c/p\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki and Istanbul and was approved by the ethics committee of the Hospital General Universitario Gregorio Mara\u0026ntilde;\u0026oacute;n, which waived informed consent for the collection of clinical data (Code: MICRO.HGUGM.2022-026). All the processes satisfied the local data confidentiality requirements.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eThe results of continuous variables are presented as median and interquartile range (percentile 25; percentile 75). For categorical variables, results are shown in frequencies and percentages. Normality analysis was studied from frequency histograms and with the Kolmogorov-Smirnov test.\u003c/p\u003e \u003cp\u003eTo study the differences in means between the two groups, parametric tests (Student's t-test or ANOVA) or non-parametric tests (Mann-Whitney or Kruskal-Wallis) were used, choosing the most appropriate one in each case based on the normality of the data and the total number of patients in each group. The association between qualitative variables was studied using Pearson's chi-square test or Fisher's exact test.\u003c/p\u003e \u003cp\u003eTo study the predictive factors of loss to follow-up, Kaplan-Meier curves and Cox regression were utilized. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 25.0. (IBM Corp., Armonk, NY). Bilateral tests were employed, and results with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eBetween1st January 2019 to 31st December 2022, the ID Unit of HGUGM received 500 new patients diagnosed with HIV infection. Among these, 203 were newly diagnosed cases (53 in 2019, 38 in 2020, 49 in 2021, 60 in 2022) and 297 were patients referred from other healthcare centers to HGUGM for continuity of HIV care and treatment (62 in 2019, 45 in 2020, 53 in 2021, 135 in 2022). 86 of all these patients were referred from an NGO, of which 21 were newly diagnosed with HIV infection and 67 were patients with previously known infection. In 2019, no patients were referred from an NGO, in 2020 only one for continuity of care for a known HIV infection, and in 2021 seven patients, three of whom were newly diagnosed with the infection. In 2022, following the direct referral program established with COGAM, the number increased to 78 patients with HIV infection referred from NGOs: 17 were naive cases and the rest were previously diagnosed patients.\u003c/p\u003e \u003cp\u003eOf the total 500 patients, their epidemiological, clinical and social characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEpidemiological, clinical and social characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNew diagnosis (n\u0026thinsp;=\u0026thinsp;203)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eFollow up (n\u0026thinsp;=\u0026thinsp;297)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eOverall (n\u0026thinsp;=\u0026thinsp;500)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNGO\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo NGO\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;182)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNGO\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo NGO\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;230)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNGO\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo NGO\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;412)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (25\u0026ndash;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (30\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (28\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37 (30\u0026ndash;49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30 (28\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e37 (30\u0026ndash;47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex:\u003c/p\u003e \u003cp\u003e\u0026bull; Men\u003c/p\u003e \u003cp\u003e\u0026bull; Women\u003c/p\u003e \u003cp\u003e\u0026bull; Trans women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (95%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e154 (85)\u003c/p\u003e \u003cp\u003e21 (11%)\u003c/p\u003e \u003cp\u003e7 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1878\u003c/p\u003e \u003cp\u003e0.1002\u003c/p\u003e \u003cp\u003e0.8382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63 (94%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e4 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e191 (83%)\u003c/p\u003e \u003cp\u003e29 (13%)\u003c/p\u003e \u003cp\u003e10 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0245\u003c/p\u003e \u003cp\u003e0.0022\u003c/p\u003e \u003cp\u003e0.5814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e83 (94%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e5(6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e345 (84%)\u003c/p\u003e \u003cp\u003e50 (12%)\u003c/p\u003e \u003cp\u003e17 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.0103\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e0.0006\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e0.5184\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountry of origin:\u003c/p\u003e \u003cp\u003e\u0026bull; Spain\u003c/p\u003e \u003cp\u003e\u0026bull; Rest of Europe\u003c/p\u003e \u003cp\u003e\u0026bull; Venezuela\u003c/p\u003e \u003cp\u003e\u0026bull; Colombia\u003c/p\u003e \u003cp\u003e\u0026bull; Peru\u003c/p\u003e \u003cp\u003e\u0026bull; Rest of latinamerica\u003c/p\u003e \u003cp\u003e\u0026bull; Morroco\u003c/p\u003e \u003cp\u003e\u0026bull; Subsaharan Africa\u003c/p\u003e \u003cp\u003e\u0026bull; Others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (14%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e7 (33%)\u003c/p\u003e \u003cp\u003e4 (19%)\u003c/p\u003e \u003cp\u003e3 (15%)\u003c/p\u003e \u003cp\u003e4 (19%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (44%)\u003c/p\u003e \u003cp\u003e5 (3%)\u003c/p\u003e \u003cp\u003e24 (13%)\u003c/p\u003e \u003cp\u003e9 (5%)\u003c/p\u003e \u003cp\u003e14 (8%)\u003c/p\u003e \u003cp\u003e32 (18%)\u003c/p\u003e \u003cp\u003e10 (5%)\u003c/p\u003e \u003cp\u003e4 (2%)\u003c/p\u003e \u003cp\u003e3 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0078\u003c/p\u003e \u003cp\u003e0.4418\u003c/p\u003e \u003cp\u003e0.0151\u003c/p\u003e \u003cp\u003e0.0124\u003c/p\u003e \u003cp\u003e0.3017\u003c/p\u003e \u003cp\u003e0.8678\u003c/p\u003e \u003cp\u003e0.2706\u003c/p\u003e \u003cp\u003e0.4926\u003c/p\u003e \u003cp\u003e0.5534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e2 (3%)\u003c/p\u003e \u003cp\u003e18 (27%)\u003c/p\u003e \u003cp\u003e26 (39%)\u003c/p\u003e \u003cp\u003e7 (10%)\u003c/p\u003e \u003cp\u003e13 (19%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73 (32%)\u003c/p\u003e \u003cp\u003e15 (6%)\u003c/p\u003e \u003cp\u003e38 (16%)\u003c/p\u003e \u003cp\u003e24 (10%)\u003c/p\u003e \u003cp\u003e18 (8%)\u003c/p\u003e \u003cp\u003e50 (22%)\u003c/p\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003cp\u003e6 (3%)\u003c/p\u003e \u003cp\u003e4 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003cp\u003e0.2728\u003c/p\u003e \u003cp\u003e0.0568\u003c/p\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003cp\u003e0.4964\u003c/p\u003e \u003cp\u003e0.6806\u003c/p\u003e \u003cp\u003e0.4438\u003c/p\u003e \u003cp\u003e0.1817\u003c/p\u003e \u003cp\u003e0.8902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (3%)\u003c/p\u003e \u003cp\u003e2 (2%)\u003c/p\u003e \u003cp\u003e25(29%)\u003c/p\u003e \u003cp\u003e30 (34%)\u003c/p\u003e \u003cp\u003e10 (12%)\u003c/p\u003e \u003cp\u003e17 (19%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e154 (37%)\u003c/p\u003e \u003cp\u003e20 (5%)\u003c/p\u003e \u003cp\u003e62 (15%)\u003c/p\u003e \u003cp\u003e33 (8%)\u003c/p\u003e \u003cp\u003e32 (8%)\u003c/p\u003e \u003cp\u003e82 (20%)\u003c/p\u003e \u003cp\u003e12 (3%)\u003c/p\u003e \u003cp\u003e10 (2%)\u003c/p\u003e \u003cp\u003e7 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.0000\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e0.2838\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e0.0027\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e0.0000\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e0.2695\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e0.9006\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e0.1051\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e0.1399\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e0.7026\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime in Spain (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (13\u0026ndash;118)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (2\u0026ndash;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (1\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 (1\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e28 (4\u0026ndash;96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial Healthcare coverage\u003c/p\u003e \u003cp\u003e\u0026bull; No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59 (88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48 (21\u0026amp;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e69 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e62 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.0000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal Healthcare coverage\u003c/p\u003e \u003cp\u003e\u0026bull; NO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e27 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eREFERRED FROM\u003c/p\u003e \u003cp\u003eEmergency room\u003c/p\u003e \u003cp\u003eOther hospital ward\u003c/p\u003e \u003cp\u003ePrimary Care\u003c/p\u003e \u003cp\u003eSTI Clinic\u003c/p\u003e \u003cp\u003eOther hospital in Madrid\u003c/p\u003e \u003cp\u003eOther hospital outside Madrid\u003c/p\u003e \u003cp\u003eOther/unkown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (22%)\u003c/p\u003e \u003cp\u003e52 (29%)\u003c/p\u003e \u003cp\u003e48 (26%)\u003c/p\u003e \u003cp\u003e16 (9%)\u003c/p\u003e \u003cp\u003e6 (3%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e20 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (14%)\u003c/p\u003e \u003cp\u003e22 (10%)\u003c/p\u003e \u003cp\u003e47 (20%)\u003c/p\u003e \u003cp\u003e9 (4%)\u003c/p\u003e \u003cp\u003e26 (11%)\u003c/p\u003e \u003cp\u003e26 (11%)\u003c/p\u003e \u003cp\u003e69 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e71 (17%)\u003c/p\u003e \u003cp\u003e74 (18%)\u003c/p\u003e \u003cp\u003e95 (23%)\u003c/p\u003e \u003cp\u003e25 (6%)\u003c/p\u003e \u003cp\u003e32 (8%)\u003c/p\u003e \u003cp\u003e26 (6%)\u003c/p\u003e \u003cp\u003e89 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime of HIV Infection (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (2\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (4\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk group\u003c/p\u003e \u003cp\u003eMSM\u003c/p\u003e \u003cp\u003eHetero\u003c/p\u003e \u003cp\u003eIVDU\u003c/p\u003e \u003cp\u003eMSM/IVDU\u003c/p\u003e \u003cp\u003eOther/unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133 (76%)\u003c/p\u003e \u003cp\u003e34 (20%)\u003c/p\u003e \u003cp\u003e3 (2%)\u003c/p\u003e \u003cp\u003e4 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0123\u003c/p\u003e \u003cp\u003e0.0258\u003c/p\u003e \u003cp\u003e0.5442\u003c/p\u003e \u003cp\u003e0.4827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65 (98.5%)\u003c/p\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e166 (75%)\u003c/p\u003e \u003cp\u003e32 (14%)\u003c/p\u003e \u003cp\u003e21 (9%)\u003c/p\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003cp\u003e0.0040\u003c/p\u003e \u003cp\u003e0.0096\u003c/p\u003e \u003cp\u003e0.4401\u003c/p\u003e \u003cp\u003e0.4401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e86 (99%\u003c/p\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e299 (75%)\u003c/p\u003e \u003cp\u003e66 (17%)\u003c/p\u003e \u003cp\u003e24 (6%)\u003c/p\u003e \u003cp\u003e6 (1.5%)\u003c/p\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003cp\u003e0.0187\u003c/p\u003e \u003cp\u003e0.2486\u003c/p\u003e \u003cp\u003e0.5071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior AIDS condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e56 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal CD4 count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e394 (256\u0026ndash;537)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e358 (195\u0026ndash;555)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e665 (505\u0026ndash;842)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e624 (402\u0026ndash;879)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasal Viral load -log\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetectable viral load for ART interruption at recruitment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelay on ART initiation (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (2\u0026ndash;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (7\u0026ndash;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAIDS condition at recruitment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.0159\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTD basal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.9725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e96 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.7510\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuantiferon +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.8897\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e39 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.5392\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive TB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6551\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.4433\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo HIV related diseases:\u003c/p\u003e \u003cp\u003eCardiovascular\u003c/p\u003e \u003cp\u003eOncological\u003c/p\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003cp\u003eNephropathy\u003c/p\u003e \u003cp\u003eRespiratory Disease\u003c/p\u003e \u003cp\u003eLiver Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1 (5%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2%)\u003c/p\u003e \u003cp\u003e6 (3%)\u003c/p\u003e \u003cp\u003e9 (5%)\u003c/p\u003e \u003cp\u003e4 (2%)\u003c/p\u003e \u003cp\u003e4 (2%)\u003c/p\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003cp\u003e4 (2%)\u003c/p\u003e \u003cp\u003e5 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5522\u003c/p\u003e \u003cp\u003e0.3970\u003c/p\u003e \u003cp\u003e0.9664\u003c/p\u003e \u003cp\u003e0.4914\u003c/p\u003e \u003cp\u003e0.4914\u003c/p\u003e \u003cp\u003e0.6283\u003c/p\u003e \u003cp\u003e0.4902\u003c/p\u003e \u003cp\u003e0.4406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e6 (9%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (3%)\u003c/p\u003e \u003cp\u003e6 (3%)\u003c/p\u003e \u003cp\u003e17 (8%)\u003c/p\u003e \u003cp\u003e8 (4%)\u003c/p\u003e \u003cp\u003e28 (12%)\u003c/p\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003cp\u003e5 (2%)\u003c/p\u003e \u003cp\u003e27 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1466\u003c/p\u003e \u003cp\u003e0.5902\u003c/p\u003e \u003cp\u003e0.0213\u003c/p\u003e \u003cp\u003e0.1201\u003c/p\u003e \u003cp\u003e0.4536\u003c/p\u003e \u003cp\u003e0.4418\u003c/p\u003e \u003cp\u003e0.7210\u003c/p\u003e \u003cp\u003e0.0031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e6 (7%\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10 (2%)\u003c/p\u003e \u003cp\u003e12 (3%)\u003c/p\u003e \u003cp\u003e26 (6%)\u003c/p\u003e \u003cp\u003e12 (3%)\u003c/p\u003e \u003cp\u003e32 (8%)\u003c/p\u003e \u003cp\u003e4 (1%)\u003c/p\u003e \u003cp\u003e9 (2%)\u003c/p\u003e \u003cp\u003e32 (8%))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.1384\u003c/p\u003e \u003cp\u003e0.3378\u003c/p\u003e \u003cp\u003e0.0500\u003c/p\u003e \u003cp\u003e0.1038\u003c/p\u003e \u003cp\u003e0.7474\u003c/p\u003e \u003cp\u003e0.3516\u003c/p\u003e \u003cp\u003e0.5174\u003c/p\u003e \u003cp\u003e0.0067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTD while follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.8614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e73 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.7977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClosure:\u003c/p\u003e \u003cp\u003e1: active follow-up\u003c/p\u003e \u003cp\u003e2: move to other region\u003c/p\u003e \u003cp\u003e3: move to other country\u003c/p\u003e \u003cp\u003e4: return to original country\u003c/p\u003e \u003cp\u003e5: lost of follow-up\u003c/p\u003e \u003cp\u003e6: jail\u003c/p\u003e \u003cp\u003e7: death\u003c/p\u003e \u003cp\u003e8. change of hospital in Madrid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (76%)\u003c/p\u003e \u003cp\u003e1 (5%)\u003c/p\u003e \u003cp\u003e1 (5%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e2 (9%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e156 (86%)\u003c/p\u003e \u003cp\u003e9 (5%)\u003c/p\u003e \u003cp\u003e3 (1.5%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e8 (4%)\u003c/p\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003cp\u003e3 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2506\u003c/p\u003e \u003cp\u003e0.9707\u003c/p\u003e \u003cp\u003e0.3310\u003c/p\u003e \u003cp\u003e0.3039\u003c/p\u003e \u003cp\u003e0.7335\u003c/p\u003e \u003cp\u003e0.6293\u003c/p\u003e \u003cp\u003e0.3310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50 (75%)\u003c/p\u003e \u003cp\u003e3 (5%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e12 (18%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e2 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e179 (78%)\u003c/p\u003e \u003cp\u003e19 (8%)\u003c/p\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003cp\u003e3 (1%)\u003c/p\u003e \u003cp\u003e21 (9%)\u003c/p\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e6 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5834\u003c/p\u003e \u003cp\u003e0.2981\u003c/p\u003e \u003cp\u003e0.5888\u003c/p\u003e \u003cp\u003e0.3474\u003c/p\u003e \u003cp\u003e0.0442\u003c/p\u003e \u003cp\u003e0.5888\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0.8670\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e335 (82%)\u003c/p\u003e \u003cp\u003e28 (7%)\u003c/p\u003e \u003cp\u003e4 (1%)\u003c/p\u003e \u003cp\u003e3 (1%)\u003c/p\u003e \u003cp\u003e29 (7%)\u003c/p\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003cp\u003e9 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e66 (75%)\u003c/p\u003e \u003cp\u003e4 (5%)\u003c/p\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e14 (16%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e3 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.1775\u003c/p\u003e \u003cp\u003e0.4336\u003c/p\u003e \u003cp\u003e0.8874\u003c/p\u003e \u003cp\u003e0.4220\u003c/p\u003e \u003cp\u003e0.0071\u003c/p\u003e \u003cp\u003e0.5125\u003c/p\u003e \u003cp\u003e0.5125\u003c/p\u003e \u003cp\u003e0.4956\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAt the end of the study, there were 43 (9%) patients who were lost to follow-up (LFU) from the total included, of which 14 (16%) came from NGOs. 8% (401) of the overall patients in the study maintained active follow-up at the end of the study period; and 75% (66) of those coming from NGOs. When analyzing other causes to discontinue follow-up in our clinic apart from LFU, such as transfer to another hospital, move to other Community in Spain, or return to country of origin, no differences were found between patients from the NGO compared to those who had accessed our ID service through other means. A multivariate analysis of factors associated with LFU was conducted using Cox regression and adjusting for country of origin other than Spain; NGO origin; time in Spain (less than 1 year, between 1 and 10 years, and more than 10 years); IV drug user risk group, CDC stage C; and health coverage at the end of the study. Only the absence of health coverage at the time of study closure reached statistical significance as an independent factor for LFU (HR 5.19, CI 2.76\u0026ndash;9.47). Other factors such as coming from an NGO (HR 1.94, CI 0.99\u0026ndash;3.89) or being from a country other than Spain (HR 3.08, CI 0.93\u0026ndash;10.16) nearly reached significance. It is important to note that the number of losses in the overall study is small, which limits this analysis. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor naive patients, establishing a direct referral pathway to the hospital from the NGO helped shorten the time from HIV diagnosis to the initiation of antiretroviral therapy (ART): 6 days for naive patients from an NGO, compared to 14 days for other newly diagnosed individuals (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.054). Hence, we aimed to analyze whether early initiation of ART was associated with a higher LFU. For this, a multivariate analysis using Cox regression for LFU in the naive patients of our study was conducted, adjusted for: delay in the start of ART (less than 7 days, between 7 and 14 days, and more than 14 days); country of origin other than Spain; NGO origin; time in Spain (less than 1 year, between 1 and 10 years, and more than 10 years); CDC stage C; and health coverage at the end of the study. None of these factors showed statistical significance as predictors of loss to follow-up, although the number of losses to follow-up was very small, limiting the power of the analysis. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe project presented demonstrates that the collaboration of health institutions with NGOs in conducting community interventions is an essential strategy for linking PLHIV to the healthcare system. In the epidemiological control of HIV infection, the challenge is to provide access to ART for every infected patient. Globally, obtaining these drugs requires visiting healthcare institutions, typically hospitals, where the medication is dispensed. In this process, PLHIV may encounter multiple barriers that ultimately impede achieving the UNAIDS targets for 2030 \u0026ldquo;95-95-95\u0026rdquo;. These barriers vary by individual according to his geographic area of residence and the healthcare setting he is in; but globally the main issues are stigma and difficulty accessing healthcare facilities to obtain medication [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These two aspects also have an impact on the psychological sphere, worsening the negative health and wellbeing effects of the infection [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding stigma, often stigma inherent to HIV infection overlaps with that linked to certain groups such as men who have sex with men, transgender people, non-Caucasian races, or migrants [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Concerning accessibility to healthcare, while ART is available worldwide, there are obstacles such as the physical distance from a patient's residence to healthcare centers; or the lack of health coverage that prevents the admission on healthcare system. Addressing all these issues is where healthcare institutions have many limitations, and where direct collaboration with NGOs can be of great help.\u003c/p\u003e \u003cp\u003eIn public health, for the prevention in transmission of infections that are a threat to the community, collaboration between governments and NGOs has led to improvements in epidemiological control [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Regarding HIV, NGOs have always played a crucial role in preventing infection and in accessing treatment for infected individuals, serving as a link with socially excluded groups such as sex workers, drug addicts, migrants, or the homosexual population [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConcerning PLHIV and individuals at risk of infection, in countries where stigma towards the community of men who have sex with men has been identified as the main obstacle to accessing HIV diagnosis, such as China [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], India [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], or Cameroon[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], community strategies have been implemented to facilitate access to the healthcare system and antiretroviral medication.\u003c/p\u003e \u003cp\u003eIn Western countries where health standards and legislation should be favorable to ensuring therapeutic coverage for PLHIV, there are still infected individuals who do not undergo treatment. The migrant population is particularly vulnerable [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], representing over 50% of new HIV infection diagnoses in Spain [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], most of them late presenters [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Therefore, screening and counseling strategies are necessary in this population [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Despite optimizing resources from institutions, it is imperative to intervene directly in the community so collaboration with NGOs is essential. In Catalonia (Spain), there is already close collaboration with HIV-related NGOs, and currently, 30% of new HIV infection diagnoses in this region are made in these organizations [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur work is conducted in Madrid, where coverage for patients with public health diseases, including HIV infection, is universal and free. However, the program presented in this work, involving direct collaboration with NGOs for community intervention, has allowed us to reach a population that does not enter healthcare system through conventional channels, and to whom we were not previously providing coverage, posing a threat to the epidemiological control of HIV pandemic. In our analysis, we found distinctive characteristics of these individuals compared to the rest of PLHIV. They were, essentially, men or transgender women infected by sexual transmission, predominantly newly arrived migrants to Spain in irregular administrative situation. Almost all came from Latin American countries. Overall, no differences were observed in terms of HIV clinical manifestations, immunovirological status, or presence of other comorbidities.\u003c/p\u003e \u003cp\u003eWe analyzed sexually transmitted infections (STIs) that were registered in clinical records by the time patients were first seen in the hospital and also throughout the follow-up in our center. We emphasize that the main objective of this study was not the analysis of STIs and that the direct collaboration project with the NGO focused on HIV infection, without any specific diagnostic or therapeutic strategy for STIs. Therefore, we believe that the STIs incidence found in our study may be underestimated. Despite this, that incidence was remarkable in both groups as 17% of PLHIV from the total individuals included in the study presented some type of STI during follow-up in our center.\u003c/p\u003e \u003cp\u003eSimultaneously, the establishment of a direct referral pathway has allowed prompt evaluation of these HIV patients in the hospital, streamlining the initiation of ART in naive patients. Strategies for rapid initiation of ART have been questioned for their potential limitations in promoting linkage to healthcare system for PLHIV, particularly for vulnerable populations [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, some studies conducted in low-income countries seem to indicate the opposite [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], as well as publications in vulnerable populations in the United States [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In our work, in naive patients, we did not find differences in the risk of LFU in those who initiated ART in the first 7 days compared to those initiated in the first 14 days or later, although a limitation of our analysis is that the number of losses was very low. On the other hand, our community interventional program for diagnosis and referral to healthcare in PLHIV did not find a favorable impact on early diagnosis of HIV infection, as the median CD4 count at diagnosis in na\u0026iuml;ve patients was similar in both groups, derived and not derived from NGOs, although that median was above 350 cells/microliter.\u003c/p\u003e \u003cp\u003eIn the presented collaboration project between HGUGM and the NGO COGAM for the direct referral of PLHIV to the hospital, social workers from both institutions were integrated. They provided counseling and administrative assistance to migrant population, thereby achieving integration into the healthcare system for most of the included patients. Thus, while patients from NGOs compared to those accessing the healthcare system through other channels were significatively higher on administrative exclusion at the start and at the end of the study, the proportion of patients from NGOs in social exclusion decreased from 78% upon arrival at the hospital to 26% at the end of the study due to the work of the social workers. This had a very favorable impact on treatment adherence and linkage to care, as reflected in administrative exclusion being the only factor related to LFU in our analysis. The legal absence of healthcare coverage had already been identified in previous studies as the main barrier to access to ART in Europe [\u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eDirect collaboration with NGOs to reinforce the diagnosis, medical follow-up, and treatment adherence of people living with HIV infection allows for direct intervention in the community, accessing a group of patients who do not use standardized referral channels. These PLHIV are primarily migrant homosexual men from South American countries, newly arrived in Spain and still in administrative exclusion. Despite the availability of ART in Spain, this situation of administrative exclusion is the main barrier to accessing the healthcare system and the main factor associated with loss to follow-up in PLHIV. Collaboration with NGOs within a multidisciplinary team including doctors, nurses, and social workers facilitates the administrative incorporation into healthcare systems of individuals in exclusion. Furthermore, establishing a direct referral pathway to Infectious Diseases Services in newly diagnosed naive HIV patients shortens the time to initiate ART without impacting treatment adherence or retention in the healthcare system.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNGO: non-governmental organization\u003c/p\u003e\n\u003cp\u003eART: antiretroviral treatment\u003c/p\u003e\n\u003cp\u003eHIV: human immunodeficiency virus\u003c/p\u003e\n\u003cp\u003ePLHIV: people living with HIV\u003c/p\u003e\n\u003cp\u003eLGBT+: lesbian, gays, bisexual, transgender\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eID: Infectious Diseases\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHGUGM: Gregorio Mara\u0026ntilde;\u0026oacute;n University Hospital\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eACKNOWLEDGEMESTS:\u003c/p\u003e\n\u003cp\u003eGilead Grants,\u0026nbsp;project number:14855\u003c/p\u003e\n\u003cp\u003eAUTHOR\u0026acute;S CONTRIBUTIONS:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTeresa Aldamiz-Echevarria (TAE), Chiara Fanciulli (CF), M\u0026oacute;nica L\u0026oacute;pez (ML), Leire P\u0026eacute;rez (LP), Francisco Tejerina (FT), David S\u0026aacute;nchez (DS), Blanca Lodeiro (BL), Juan Carlos L\u0026oacute;pez (JCL), Juan Brerenguer (JB), Cristina Diez (CD) contributed to the study development, data collection, data analysis and redaction of the manuscript\u003c/p\u003e\n\u003cp\u003eJose Maria Bell\u0026oacute;n (JMB) contributed in the statistical analysis\u003c/p\u003e\n\u003cp\u003eMaria Ferris (MF), Mario Blazquez (MB), Almudena Calvo (AC), Mario Domene (MD), Oswaldo Vegas (OV), Carmen Rodriguez (CR) contributed to the study development\u003c/p\u003e\n\u003cp\u003ePatricia Mu\u0026ntilde;oz (PM), Paloma Gij\u0026oacute;n (PG), Pedro Montilla (PM), Elena Berm\u0026uacute;dez (EB), Maricela Valerio (MV), Roberto Alonso (RA), Belen Padrilla (BP), Cristina Ventimilla (CV) contributed to the study development and redaction of the manuscript\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: Data is provided within the manuscript\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate:\u0026nbsp;The study has been approved by the ethics committee of the Gregorio Mara\u0026ntilde;\u0026oacute;n Hospital (Code: MICRO.HGUGM.2022-026).\u003c/p\u003e\n\u003cp\u003eConsent for publication: all authors agree for publication\u003c/p\u003e\n\u003cp\u003eCompeting interests: the authors have no competitive interests\u003c/p\u003e\n\u003cp\u003eFunding. This project received grant from Gilead Grants (project number:14855).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JH, Godbole SV, Chariyalertsak S, Santos BR, Mayer KH, Hoffman IF, Eshleman SH, Piwowar-Manning E, Cottle L, Zhang XC, Makhema J, Mills LA, Panchia R, Faesen S, Eron J, Gallant J, Havlir D, Swindells S, Elharrar V, Burns D, Taha TE, Nielsen-Saines K, Celentano DD, Essex M, Hudelson SE, Redd AD, Fleming TR; HPTN 052 Study Team. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med. 2016 Sep 1;375(9):830-9.\u003c/li\u003e\n\u003cli\u003eRodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Degen O, Corbelli GM, Estrada V, Geretti AM, Beloukas A, Raben D, Coll P, Antinori A, Nwokolo N, Rieger A, Prins JM, Blaxhult A, Weber R, Van Eeden A, Brockmeyer NH, Clarke A, Del Romero Guerrero J, Raffi F, Bogner JR, Wandeler G, Gerstoft J, Guti\u0026eacute;rrez F, Brinkman K, Kitchen M, Ostergaard L, Leon A, Ristola M, Jessen H, Stellbrink HJ, Phillips AN, Lundgren J; PARTNER Study Group. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet. 2019 Jun 15;393(10189):2428-2438.\u003c/li\u003e\n\u003cli\u003eLundgren JD, Babiker AG, Sharma S, Grund B, Phillips AN, Matthews G, Kan VL, Aagaard B, Abo I, Alston B, Arenas-Pinto A, Avihingsanon A, Badal-Faesen S, Brites C, Carey C, Casseb J, Clarke A, Collins S, Corbelli GM, Dao S, Denning ET, Emery S, Eriobu N, Florence E, Furrer H, F\u0026auml;tkenheuer G, Gerstoft J, Gissl\u0026eacute;n M, Goodall K, Henry K, Horban A, Hoy J, Hudson F, Azwa RISR, Kedem E, Kelleher A, Kityo C, Klingman K, Rosa A, Leturque N, Lifson AR, Losso M, Lutaakome J, Madero JS, Mallon P, Mansinho K, Filali KME, Molina JM, Murray DD, Nagalingeswaran K, Nozza S, Ormaasen V, Paredes R, Peireira LC, Pillay S, Polizzotto MN, Raben D, Rieger A, Sanchez A, Schechter M, Sedlacek D, Staub T, Touloumi G, Turner M, Madruga JV, Vjecha M, Wolff M, Wood R, Zilmer K, Lane HC, Neaton JD; INSIGHT Strategic Timing of AntiRetroviral Treatment (START) Study Group. Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection. NEJM Evid. 2023 Mar;2(3):10.1056/evidoa2200302.\u003c/li\u003e\n\u003cli\u003ehttps://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf (19 May 2024, date last accessed).\u003c/li\u003e\n\u003cli\u003eFrescura L, Godfrey-Faussett P, Feizzadeh A A, El-Sadr W, Syarif O, Ghys PD; on and behalf of the 2025 testing treatment target Working Group. Achieving the 95 95 95 targets for all: A pathway to ending AIDS. PLoS One. 2022 Aug 4;17(8):e0272405.\u003c/li\u003e\n\u003cli\u003eMinisterio de Sanidad, Servicios Sociales e Igualdad. Bolet\u0026iacute;n Oficial del Estado\u0026mdash; Legislaci\u0026oacute;n Consolidada, 2012. Available at: http://www.msssi.gob.es/profesionales/ prestacionesSanitarias/CarteraDeServicios/docs/RDL_16_2012.pdf (19 May 2024, date last accessed).\u003c/li\u003e\n\u003cli\u003eNdumbi P, Del Romero J, Pulido F, Velasco Arribas M, Dronda F, Blanco Ramos JR, Garc\u0026iacute;a de Olalla P, Oca\u0026ntilde;a I, Belda-Iba\u0026ntilde;ez J, Del Amo J, \u0026Aacute;lvarez-Del Arco D; aMASE Research Group. Barriers to health care services for migrants living with HIV in Spain. Eur J Public Health. 2018 Jun 1;28(3):451-457.\u003c/li\u003e\n\u003cli\u003eLatkin C, Weeks MR, Glasman L, Galletly C, Albarracin D. A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS Behav. 2010 Dec;14(Suppl 2):222-38.\u003c/li\u003e\n\u003cli\u003eAuerbach JD, Parkhurst JO, C\u0026aacute;ceres CF. Addressing social drivers of HIV/AIDS for the long-term response: conceptual and methodological considerations. Glob Public Health. 2011;6 Suppl 3:S293-309.\u003c/li\u003e\n\u003cli\u003eArora AK, Ortiz-Paredes D, Engler K, Lessard D, Mate KKV, Rodriguez-Cruz A, Kronfli N, Vedel I, Cox J, Quesnel-Vall\u0026eacute;e A, Lebouch\u0026eacute; B. Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review. AIDS Patient Care STDS. 2021 Aug;35(8):288-307.\u003c/li\u003e\n\u003cli\u003eQiao S, Li X, Stanton B. Social support and HIV-related risk behaviors: a systematic review of the global literature. AIDS Behav. 2014 Feb;18(2):419-41.\u003c/li\u003e\n\u003cli\u003eFlowers P, Davis M, Hart G, et al. Diagnosis and stigma and identity amongst HIV positive Black Africans living in the UK. Psychol Health 2006;21:109\u0026ndash;22.\u003c/li\u003e\n\u003cli\u003eBoyd AE, Murad S, O\u0026rsquo;shea S, et al. Ethnic differences in stage of presentation of adults newly diagnosed with HIV-1 infection in south London. HIV Med 2005;6: 59\u0026ndash;65.\u003c/li\u003e\n\u003cli\u003eScheppers E, van Dongen E, Dekker J, et al. Potential barriers to the use of health services among ethnic minorities: a review. Family Practice 2006; 23:325\u0026ndash;48.\u003c/li\u003e\n\u003cli\u003eDeblonde J, De Koker P, Hamers FF, et al. Barriers to HIV testing in Europe: a systematic review. Eur J Pub Health 2010; 20:422\u0026ndash;32\u003c/li\u003e\n\u003cli\u003eSanadgol A, Doshmangir L, Majdzadeh R, Gordeev VS. Engagement of non-governmental organisations in moving towards universal health coverage: a scoping review. Global Health. 2021 Nov 16;17(1):129.\u003c/li\u003e\n\u003cli\u003eRajabi M, Ebrahimi P, Aryankhesal A. Collaboration between the government and nongovernmental organizations in providing health-care services: A systematic review of challenges. J Educ Health Promot. 2021 Jun 30;10:242.\u003c/li\u003e\n\u003cli\u003eZafar Ullah AN, Newell JN, Ahmed JU, Hyder MK, Islam A. Government-NGO collaboration: the case of tuberculosis control in Bangladesh. Health Policy Plan. 2006 Mar;21(2):143-55.\u003c/li\u003e\n\u003cli\u003eRangan SG, Juvekar SK, Rasalpurkar SB, Morankar SN, Joshi AN, Porter JD. Tuberculosis control in rural India: lessons from public-private collaboration. Int J Tuberc Lung Dis. 2004 May;8(5):552-9.\u003c/li\u003e\n\u003cli\u003eKelly JA, Somlai AM, Benotsch EG, Amirkhanian YA, Fernandez MI, Stevenson LY, Sitzler CA, McAuliffe TL, Brown KD, Opgenorth KM. Programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. \u003cem\u003eAIDS Care.\u003c/em\u003e\u003cem\u003e \u003c/em\u003e2006;\u003cstrong\u003e18\u003c/strong\u003e:12\u0026ndash;21.\u003c/li\u003e\n\u003cli\u003eSehgal PN. Prevention and control of AIDS: the role of NGOs. \u003cem\u003eHealth Millions.\u003c/em\u003e\u003cem\u003e \u003c/em\u003e1991;\u003cstrong\u003e17\u003c/strong\u003e:31\u0026ndash;33.\u003c/li\u003e\n\u003cli\u003eChow EP, Lau JT, Zhuang X, Zhang X, Wang Y, Zhang L. HIV prevalence trends, risky behaviours, and governmental and community responses to the epidemic among men who have sex with men in China. Biomed Res Int. 2014;2014:607261.\u003c/li\u003e\n\u003cli\u003eBhutada K, Chakrapani V, Gulfam FR, Ross J, Golub SA, Safren SA, Prasad R, Patel VV. Pathways Between Intersectional Stigma and HIV Treatment Engagement Among Men Who Have Sex with Men (MSM) in India. J Int Assoc Provid AIDS Care. 2023 Jan-Dec;22:23259582231199398.\u003c/li\u003e\n\u003cli\u003eHolland CE, Papworth E, Billong SC, Kassegne S, Petitbon F, Mondoleba V, Moukam LV, Macauley I, Eyene Ntsama SP, Yomb YR, Eloundou J, Mananga F, Tamoufe U, Baral SD. Access to HIV Services at Non-Governmental and Community-Based Organizations among Men Who Have Sex with Men (MSM) in Cameroon: An Integrated Biological and Behavioral Surveillance Analysis. PLoS One. 2015 Apr 23;10(4):e0122881.\u003c/li\u003e\n\u003cli\u003ePark JN, Papworth E, Billong SC, Elat JB, Kassegne S, Grosso A, Moukam L, Macauley I, Yomb YR, Mondoleba V, Eloundou J, LeBreton M, Ketende SC, Baral S. Correlates of prior HIV testing among men who have sex with men in Cameroon: a cross-sectional analysis. BMC Public Health. 2014 Nov 25;14:1220.\u003c/li\u003e\n\u003cli\u003eDeblonde, J., Sasse, A., Del Amo, J. \u003cem\u003eet al.\u003c/em\u003e Restricted access to antiretroviral treatment for undocumented migrants: a bottle neck to control the HIV epidemic in the EU/EEA. \u003cem\u003eBMC Public Health\u003c/em\u003e \u003cstrong\u003e15\u003c/strong\u003e, 1228 (2015).\u003c/li\u003e\n\u003cli\u003e\u0026Aacute;rea de Vigilancia de VIH y Comportamientos de Riesgo. Vigilancia Epidemiol\u0026oacute;gica del VIH y sida en Espa\u0026ntilde;a: Sistema de Informaci\u0026oacute;n sobre Nuevos Diagn\u0026oacute;sticos de VIH y Registro Nacional de Casos de Sida. Plan Nacional Sobre el SIDA, 2016. Available at: http://www.mscbs.es/ciudadanos/enfLesiones/enfTransmisibles/sida/vigilancia/docs/Informe_VIH_SIDA_2023.pdf\u003c/li\u003e\n\u003cli\u003eMonge S, Alejos B, Dronda F, Del Romero J, Iribarren JA, Pulido F, Rubio R, Mir\u0026oacute; JM, Gutierrez F, Del Amo J; CoRIS. Inequalities in HIV disease management and progression in migrants from Latin America and sub-Saharan Africa living in Spain. HIV Med. 2013 May;14(5):273-83.\u003c/li\u003e\n\u003cli\u003eAlvarez-del Arco D, Monge S, Azcoaga A, et al. HIV testing and counselling for migrant populations living in high-income countries: a systematic review. Eur J Pub Health 2013; 23:1039\u0026ndash;45.\u003c/li\u003e\n\u003cli\u003eBerenguera A, Pujol-Ribera E, Violan C, Romaguera A, Mansilla R, Gim\u0026eacute;nez A, Ascaso C, Almeda J. Core indicators evaluation of effectiveness of HIV-AIDS preventive-control programmes carried out by nongovernmental organizations. A mixed method study. BMC Health Serv Res. 2011 Jul 28;11:176.\u003c/li\u003e\n\u003cli\u003eCarta al director: Berenguera A, Almeda J, Violan C, Pujol-Ribera E. Percepci\u0026oacute;n del riesgo de infecci\u0026oacute;n por VIH-SIDA de los usuarios de las organizaciones no gubernamentales que trabajan en la prevenci\u0026oacute;n-control del VIH-SIDA en Catalunya [Perception of the risk of HIV-AIDS infection of users by Non-Governmental Organisations (ONGs) who work in prevention-control of HIV-AIDS in Catalonia]. Aten Primaria. 2012 May;44(5):293-5. Spanish.\u003c/li\u003e\n\u003cli\u003eFord N, Migone C, Calmy A, Kerschberger B, Kanters S, Nsanzimana S, Mills EJ, Meintjes G, Vitoria M, Doherty M, Shubber Z. Benefits and risks of rapid initiation of antiretroviral therapy. AIDS. 2018 Jan 2;32(1):17-23.\u003c/li\u003e\n\u003cli\u003eCuzin L, Cotte L, Delpierre C, Allavena C, Valantin MA, Rey D, Delobel P, Pugliese P, Raffi F, Cabi\u0026eacute; A; Dat\u0026rsquo;AIDS Study group. Too fast to stay on track? Shorter time to first anti-retroviral regimen is not associated with better retention in care in the French Dat\u0026apos;AIDS cohort. PLoS One. 2019 Sep 6;14(9):e0222067.\u003c/li\u003e\n\u003cli\u003eMbatia RJ, Mtisi EL, Ismail A, Henjewele CV, Moshi SJ, Christopher AK, Nsanzugwanko NW, Bukuku AG, Msimbe RA, Kirato AR, Nyabukene FS, Mmari EJ, Rwebembera AA, Masanja BN, Kailembo A, Matiko EJ. Interruptions in treatment among adults on anti-retroviral therapy before and after test-and-treat policy in Tanzania. PLoS One. 2023 Nov 15;18(11):e0292740.\u003c/li\u003e\n\u003cli\u003eKoenig SP, Dorvil N, D\u0026eacute;vieux JG, Hedt-Gauthier BL, Riviere C, Faustin M, Lavoile K, Perodin C, Apollon A, Duverger L, McNairy ML, Hennessey KA, Souroutzidis A, Cremieux PY, Severe P, Pape JW. Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial. PLoS Med. 2017 Jul 25;14(7):e1002357.\u003c/li\u003e\n\u003cli\u003eCoffey S, Bacchetti P, Sachdev D, Bacon O, Jones D, Ospina-Norvell C, Torres S, Lynch E, Camp C, Mercer-Slomoff R, Lee S, Christopoulos K, Pilcher C, Hsu L, Jin C, Scheer S, Havlir D, Gandhi M. RAPID antiretroviral therapy: high virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population. AIDS. 2019 Apr 1;33(5):825-832.\u003c/li\u003e\n\u003cli\u003eColasanti J, Sumitani J, Mehta CC, et al. Implementation of a rapid entry program decreases time to viral suppression among vulnerable persons living with HIV in the Southern United States.\u003cem\u003e Open Forum Infect Dis\u003c/em\u003e. 2018;5(6):ofy104.\u003c/li\u003e\n\u003cli\u003eSuess A, Ruiz Perez I, Ruiz Azarola A, March Cerda JC. The right of access to health care for undocumented migrants: a revision of comparative analysis in the European context. Eur J Public Health 2014; 24:712\u0026ndash;20.\u003c/li\u003e\n\u003cli\u003eVignier N, Dray Spira R, Pannetier J, Ravalihasy A, Gosselin A, Lert F, Lydie N, Bouchaud O, Desgrees Du Lou A, Chauvin P; PARCOURS Study Group. Refusal to provide healthcare to sub-Saharan migrants in France: a comparison according to their HIV and HBV status. Eur J Public Health. 2018 Oct 1;28(5):904-910.\u003c/li\u003e\n\u003cli\u003eN\u0026ouml;stlinger C, Cosaert T, Landeghem EV, Vanhamel J, Jones G, Zenner D, Jacobi J, Noori T, Pharris A, Smith A, Hayes R, Val E, Waagensen E, Vovc E, Sehgal S, Laga M, Van Renterghem H. HIV among migrants in precarious circumstances in the EU and European Economic Area. Lancet HIV. 2022 Jun;9(6):e428-e437.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV, linkage-to-care, access to antiretroviral treatment, migrants, NGO","lastPublishedDoi":"10.21203/rs.3.rs-4862637/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4862637/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWith the aim of improving access and engagement to healthcare in people living with HIV (PLHIV), in 2022 Gregorio Mara\u0026ntilde;\u0026oacute;n Hospital and the NGO COGAM developed a circuit for recruitment and referral to hospital. Program targeted PLHIV who were neither receiving antiretroviral treatment (ART) nor on medical follow-up (FU); but also, individuals at risk who underwent screening tests at the NGO and, if positive, were referred for confirmation. The result was an increase in annual new PLHIV seen in hospital by reaching a population who were, essentially, young men (94% male, median age 30 years), migrants (95%) with recent diagnosis of HIV (median 5 years) and who were recently arrived in Spain (median 5 months). Most of them hadn\u0026acute;t healthcare coverage (78%). In multivariate analysis, that included all PLHIV seen for the first time in the ID Unit between 2019 and 2022, lack of healthcare coverage was the only independent predictor of lost to FU that reached statistical significance (HR 5.19, CI 2.76\u0026ndash;9.47). Furthermore, time from HIV diagnosis to ART initiating was shortened from 14 to 6 days without affecting linkage to care. Our conclusion is that collaboration with NGOs reinforce diagnosis, FU, and adherence to ART for PLHIV.\u003c/p\u003e","manuscriptTitle":"Direct collaboration between hospitals and NGOs, an essential tool to reinforce linkage to care in People living with HIV","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-16 18:21:40","doi":"10.21203/rs.3.rs-4862637/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-16T05:32:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-09T22:29:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31605611830623001386834882433802237785","date":"2024-11-09T03:20:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-27T15:00:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93336757932465601168499972132462967776","date":"2024-10-26T03:36:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44685011710441208623295305732744927925","date":"2024-10-23T07:42:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-30T16:52:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-30T16:50:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-20T17:38:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-19T12:07:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-08-05T14:17:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1e171f1b-4aa0-4196-adac-454bc9f30740","owner":[],"postedDate":"September 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-03T16:07:14+00:00","versionOfRecord":{"articleIdentity":"rs-4862637","link":"https://doi.org/10.1038/s41598-025-86540-8","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-01-28 15:57:07","publishedOnDateReadable":"January 28th, 2025"},"versionCreatedAt":"2024-09-16 18:21:40","video":"","vorDoi":"10.1038/s41598-025-86540-8","vorDoiUrl":"https://doi.org/10.1038/s41598-025-86540-8","workflowStages":[]},"version":"v1","identity":"rs-4862637","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4862637","identity":"rs-4862637","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}