A demographic study of patients presenting for HIV non-occupational postexposure prophylaxis and those newly diagnosed with HIV at a large urban hospital

Abstract

BackgroundThe Spencer Cox Center for Health operates non-occupational postexposure prophylaxis (nPEP) and rapid HIV screening programmes at St Luke's and Roosevelt Hospitals in New York City, USA, funded in part by the New York City Department of Health and Mental Hygiene. The aim of this study was to explore the possibility of disparities in nPEP awareness and/or accessibility by comparing the demographics of individuals presenting for nPEP and those newly diagnosed HIV-positive individuals within the same large urban hospital centre. Both programmes are collaborative efforts between the hospital's HIV centre (Spencer Cox Center for Health) and the emergency department, with patients identified primarily in the emergency department and linked to care at the HIV centre. MethodsDemographic data were extracted from electronic medical records of patients who underwent HIV rapid antibody testing and had newly diagnosed HIV infections, and of patients who received nPEP, between January, 2011, and June, 2013. All data were entered into an SPSS database for descriptive analysis. Characteristics of patients who received nPEP and those who were newly HIV diagnosed were compared with the χ2 test and Wilcoxon test. FindingsThe study population comprised 929 participants, 769 from the nPEP programme and 160 newly diagnosed through the rapid HIV screening programme. Most participants were men (774 [83%]), white (323 [35%]), and reported as a risk factor that they were men who had sex with men (540 [58%]). Mean age was 32 years (range 14–74). For those newly diagnosed with HIV with a documented CD4 cell count, 52 (42%) patients had a CD4 count of fewer than 200 cells per μL, 24 (19%) patients had CD4 count in the range 200–349 cells per μL, and 49 (39%) patients had a CD4 count of more than 350 cells per μL. Most participants resided in boroughs in New York City (799 [86%]), with 519 (56%) from Manhattan. Univariate analysis showed that nPEP patients differed significantly from those newly diagnosed with HIV by race (p<0·0001), insurance status (p<0·0001), and age (p<0·0001). nPEP patients were more likely than were those newly HIV diagnosed to be white (294 [45%] of 652 vs 29 [20%] of 144), commercially insured (392 [51%] of 769 vs 39 [24%] of 160), and young (mean age 32 years vs 37 years, t927=−6·4; p<0·0001). Newly diagnosed HIV patients were more likely to be black (68 [47%] of 144 vs 119 [18%] of 652), publicly insured (53 [33%] of 160 vs 82 [11%] of 769), and reside in the Bronx (18 [11%] of 159 vs 51 [7%] of 766). InterpretationDifferences in race, insurance status, age, and geographical area of residence suggest disparities in nPEP awareness and/or accessibility, and demonstrate a need for public health efforts to educate people about and facilitate access to nPEP in communities at high risk of HIV infection. Possible limitations of this study include varied stage of disease progression among the newly diagnosed sample, the limited number of sites providing nPEP relative to those providing HIV screening, and a lack of ability to survey the newly diagnosed population as to their awareness of nPEP. We aim to do further analysis with zip code geomapping to refine our understanding of differences in geographical distribution of patients accessing nPEP and those accessing HIV testing services. FundingThese programmes are supported in part by the New York City Department of Health and Mental Hygiene.