Sarah Rutstein, MD, PhD, and Thibaut Davy‑Mendez, PhD, MSPH, with the Institute for Global Health and Infectious Diseases have received an R01 from the National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH). Their multi-year award, entitled Leveraging Inpatient records to characterize the HIV Care continuum in North Carolina (LINC-NC), focuses on a moment that often gets overlooked in HIV care–what happens after someone with HIV leaves the hospital.
While many efforts have tried to improve linkage to care after discharge, success has been limited. One major reason is that past studies relied on fragmented or incomplete data—looking at only one health system, capturing a single moment in time, or lacking enough detail to understand the complex factors that shape a person’s ability to stay in care.
This project takes a different approach.
“Hospitalization is often a missed opportunity to engage or re‑engage people with HIV into outpatient care,” said Rutstein, assistant professor of infectious diseases. “Our study will take a comprehensive, statewide approach—bringing together clinical data, public health surveillance, and community perspectives—to better understand what happens after discharge and how we can improve long‑term outcomes for people with HIV.”
A Clearer Picture Across North Carolina
The team will bring together data that for the first time shows the full HIV care journey for people hospitalized with HIV across North Carolina. The study will combine electronic health record data from three of the state’s largest health systems (UNC, Duke Health, and Wake Forest/Atrium Health) with statewide HIV surveillance data—including viral load information—from 2018 to 2024.Using highly accurate, privacy‑protecting data‑matching techniques, people with HIV will be matched across these sources without sharing sensitive identifying information. The study will include 34 hospitals that care for roughly 80% of hospitalized people with HIV in North Carolina and draw from more than 600 inpatient and outpatient sites across all 100 counties.
This statewide view will allow researchers to see what’s happening before hospitalization, what care people receive during their hospital stay, and whether—and how—people successfully reconnect to HIV care after discharge. Differences in care outcomes across hospitals will help guide the qualitative part of the study, ensuring perspectives are gathered where challenges—and successes—are most evident.
“By integrating data across multiple health systems and pairing it with insights from patients, providers, and community organizations, this project will identify actionable targets for strengthening linkage to HIV care,” said Davy-Mendez. “Our goal is to generate evidence that can inform practical, scalable interventions and support more equitable HIV care across North Carolina.”
The resulting dataset will include information from more than 600 inpatient and outpatient sites across all 100 counties and approximately 34 hospitals—facilities that collectively care for about 80% of hospitalized people with HIV in North Carolina. Innovative data‑matching methods will be used to protect patient privacy while still allowing researchers to track key outcomes such as linkage to care, retention, and viral suppression.
Why Linkage to Care Matters
Linkage to HIV care—typically defined as completing an initial visit with an HIV medical provider soon after diagnosis or a healthcare encounter—is a critical step in the HIV care continuum. Timely linkage gives people access to antiretroviral therapy, improves individual health outcomes, and dramatically reduces HIV transmission at the population level.
This study aligns with national priorities, including the Ending the HIV Epidemic in the U.S. initiative, which emphasizes rapid linkage to care and long‑term retention as essential strategies for reducing new HIV infections and improving quality of life for people with HIV. At the conclusion of the study, investigators expect to have identified optimal targets and potential interventions for future testing to facilitate improved post-discharge HIV linkage outcomes for persons with HIV in North Carolina and beyond.
