Missed Testing Opportunities for HIV Screening and Early Diagnosis in an Urban Tertiary Care Center.

Joseph Derose,Jason Zucker,Shobha Swaminathan,David Cennimo

doi:10.1155/2017/5708620

Abstract

Newark, New Jersey, is disproportionally affected by HIV with one of the highest prevalence rates in the United States. Rutgers New Jersey Medical School is a major healthcare provider to Newark's underserved population and has implemented a HIV testing program that can diagnose and link newly diagnosed individuals to care. We conducted a retrospective chart review of all new patients seen in the Infectious Disease Practice from January 1, 2013, to December 31, 2014, to determine the proportion of patients with a missed testing opportunity (MTO) (patients with a new HIV diagnosis with an encounter at the institution in the 1 year prior to their first appointment). 117 newly diagnosed patients were identified. 36 (31%) had at least one MTO. A total of 34 (29%) of newly diagnosed patients had AIDS at presentation and 17% had CD4 counts of 50 cells/μL (p value 0.5). The two most common locations of a missed testing opportunity were the hospital ED (45%) and subspecialty clinics (37%). This study demonstrates that, even in a high prevalence institution with HIV counseling, testing, and referral service, HIV screening is lacking at multiple points of care and patients are missing opportunities for earlier diagnosis and treatment.

Highlights

The Centers for Disease Control and Prevention (CDC) estimates that over 150,000 people living in the United States with human immunodeficiency virus (HIV) are unaware of their diagnosis [1]
Implementation of policies advocating for increased HIV testing, linkage to care, and early antiretroviral therapy (ART) are key factors responsible for the decreases
The START study recently showed that HIV infected individuals have a considerably lower risk of developing AIDS or other serious complications when antiretrovirals are started earlier in their disease course, even when they are asymptomatic and have higher CD4 counts [16]

Summary

Introduction

The Centers for Disease Control and Prevention (CDC) estimates that over 150,000 people living in the United States with human immunodeficiency virus (HIV) are unaware of their diagnosis [1]. There is growing evidence that initiating antiretroviral therapy (ART) early can reduce HIV viral load as well as the number of infections and can help reduce HIV transmission at the population level [2]. Despite the improvement and availability of HIV testing centers and programs to facilitate linkage to care and treatment, 49% of those testing positive for HIV are not in care and an additional 11% of those in care are not receiving ART [4]. Of the patients receiving ART, only 30% are able to achieve adequate HIV virologic suppression [4]. Many of these challenges can contribute to the approximately fifty thousand new HIV infections per year in the United States [1]

Methods

Results

Conclusion