HIV Diagnosis Rates Research Articles

Use of electronic data to assist with long-term follow-up in an urban HIV clinic

BackgroundThe University of Chicago Medicine (UCM) HIV clinic follows up 565 patients, with case management by one social worker. This large cohort makes active case follow-up difficult. Our clinic is located in a neighbourhood on the south side of Chicago. This area includes four of the six communities with the highest annual HIV diagnosis rates in the city and contains neighbourhoods with an HIV prevalence of 1% or more. We describe a programme that used medical informatics to re-link patients lost to follow-up into care and to assist in the long-term management of this group. MethodsPatients at the UCM HIV clinic were eligible for the study if they had attended at least one appointment but had not been seen in clinic for 6 months or more, our criterion for lost to follow-up. We used an electronic clinic database and electronic medical records to identify these patients. Those patients classified as lost to follow-up were re-linked to care by clinic social workers by phone or, if that failed, by follow-up letters. Patients were contacted from February to June, 2013, by the social worker and a social work intern. In an open programme, patients will become eligible for re-linkage on a rolling basis. FindingsAmong 565 patients, 56 (10%) had not been seen for 6 months to 1 year, 40 (7%) had not been seen for 1–2 years, and 27 (5%) had not been seen for more than 2 years. Overall, 442 (78%) of our patients were retained in care and 123 (22%) patients were determined to be lost to follow-up. Age, sex, race, ethnicity, and insurance coverage did not predict lost to follow-up status. Ten patients (8%) were dead. Among 113 living patients, 64 (57%) were contacted by phone. 32 had moved or were in care elsewhere. 30 of the remaining 32 (94%) scheduled a clinic visit. Ten patients scheduled a visit in response to a letter or voicemail, but 49 (9% of the clinic cohort) remain lost to follow-up. InterpretationOur retention rate is much higher than the US national retention rate of about 40%. Nonetheless, with a large cohort, it is important to implement measures to track retention. With this aim, we found electronic data to be useful for identification of patients lost to follow-up and to aid in efforts towards retention in care. We were very successful at collecting data from or re-linking patients who we could contact by phone, but less so when we had to send a letter. In addition to re-engaging patients into care, it is important for us to know if patients have died or transferred care to adequately assess our local cascade of engagement in care. With this study we hope to show the feasibility and sustainability of clinic-wide re-linkage initiatives. FundingNone.

HIV/AIDS in the Southern USA: A disproportionate epidemic

This research synthesis examined HIV/AIDS surveillance and health care financing data and reviewed relevant research literature to describe HIV epidemiology, outcomes, funding, and contributing factors to the HIV epidemic in the Southern USA with particular focus on a group of Southern states with similar demographic and disease characteristics and comparable HIV epidemics (Alabama, Georgia, Florida, Los Angeles, Mississippi, North Carolina, South Carolina, Tennessee, and Texas). These states are hereafter referred to as “targeted Southern states.” Eight of the 10 states with the highest HIV diagnosis rates in 2011 were in the Southern USA; six were targeted states. Forty-nine percent of HIV diagnoses were in the South in 2011, which contains only 37% of the US population. The targeted states region had the highest HIV diagnosis rate than any other US region in 2011. The South was also found to have the highest HIV-related mortality and morbidity rates in the USA. The high levels of poverty, HIV-related stigma, and STDs found in the South, particularly in the targeted Southern states, likely contribute to greater HIV incidence and mortality. The disproportionate impact of HIV in the South, particularly among targeted states, demonstrates a critical need to improve HIV prevention and care and address factors that contribute to HIV disease in this region.

P3.217 International Comparison of Recent Trends in the Rates of HIV Diagnoses Among Men Who Have Sex with Men (MSM)

BackgroundAfter a rise in the early 2000s in the number of new HIV diagnoses among MSM in New Zealand, also witnessed in many developed countries, in 2011 the number dropped...

P5.023 Novel Emergency Department Registration Kiosk For HIV Screening Increases Engagement of High Risk Patients and is Cost-Effective

BackgroundHigh operating costs challenge sustainability of successful U.S. Emergency Department(ED) HIV screening programmes. Free-standing registration kiosks could potentially reduce the marginal costs of ED HIV screening. We investigated a cost-effectiveness...

P3.444 Missed STI and HIV Testing Opportunities Among Male Prisoners in England

BackgroundPrisoners are a vulnerable population potentially at higher risk of sexually transmitted infections (STI), including bloodborne viruses (BBV), yet are more likely to receive fragmented sexual health services (SHS). Until...

P3.191 Do Gains in the Prevention of HIV Lead to Losses in the Prevention of Other Sexually Transmitted Infections?

BackgroundAggressive efforts to reduce the viral load among persons with HIV infection, including early diagnosis, linkage to care, and early initiation of antiretroviral treatment may significantly reduce HIV transmission at...

P3.125 Increasing HIV Infection Among Men Who Have Sex with Men in Slovenia: Surveillance Data For 2002–2011

Background HIV surveillance in Slovenia is based on universal mandatory reporting of HIV/AIDS cases, monitoring HIV infection prevalence among several sentinel populations and behaviour surveillance in several sentinel populations. Our objective was to present HIV surveillance data for men who have sex with men (MSM) in order to inform HIV prevention and control policies. Methods We collected information on annual reported HIV cases, CD4 counts at diagnosis, HIV prevalence among male clients of STI outpatient services tested for syphilis and in a sentinel population of MSM, as well as proportion reporting “condom use” and “HIV testing last year” in the same sentinel population of MSM. Results In 2011, 35 of all 55 newly diagnosed HIV cases were reported among MSM. During 2002–2011, the annual reported incidence rate of HIV diagnoses among MSM increased from 12.6 to 48.0 per million men aged 15–64 years. The proportion of new HIV diagnosis among MSM that were late (CD4 counts Conclusion The burden of HIV among MSM in Slovenia is disproportionately high and increasing. Promotion of safer sexual behaviour and HIV testing among MSM as well as positive prevention among MSM with diagnosed HIV infection are urgently needed.

HIV Among Women in the District of Columbia: An Evolving Epidemic?

The epidemiology of HIV in urban centers of the United States such as the District of Columbia (DC) is dynamic with rates of new HIV and AIDS diagnoses as well as risk factors elevated. Correlates of HIV among heterosexual women extend beyond traditional, individual risk factors to structural factors. The purpose of this study was to compare proportions of HIV and correlates of HIV among women participating in National HIV behavioral surveillance (NHBS) system in 2006-7 (NHBS Cycle 1) and 2010 (NHBS Cycle 2). Analysis of 677 female participants at elevated risk for HIV revealed high prevalence of individual-level HIV-associated risk factors (e.g., sexual behavior) and socio-structural associated risk factors (e.g., homelessness, incarceration, lack of health insurance). While a greater proportion of women were HIV-infected in Cycle 2, after controlling for the distribution of demographic characteristics to adjust for a change in eligibility criteria, the pooled sample did not reveal a significantly increased proportion of HIV-infected women in Cycle 2. Homelessness and condom use were associated with greater relative odds of HIV after adjustment for confounders, and non-injection drug use was associated with reduced odds. Findings inform our understanding of the continuing HIV epidemic in DC and support development of effective interventions to slow the epidemic among women in DC and similar urban centers.

HIV diagnosis and utilisation of HIV-related medical care among foreign-born persons in New York City, 2001–2009

ObjectivesTo measure trends in HIV diagnoses among foreign-born (FB) New Yorkers and compare the epidemic in FB with that in non-FB (NFB).MethodsNew York City (NYC) HIV/AIDS surveillance registry data were...

HIV and AIDS in the European Union, 2011

In 2011, a total of 28,038 new HIV diagnoses were reported by European Union and European Economic Area countries. The annual rate of HIV diagnoses does not show clear signs of decrease and HIV continues to be concentrated in selected populations such as men who have sex with men and injecting drug users, and a high proportion reported as late presenters. Despite effective and available antiretroviral treatment, the number of AIDS cases increased in a few countries.

Disparities in the Burden of HIV/AIDS in Canada

BackgroundWe aimed to characterize changes in patterns of new HIV diagnoses, HIV-related mortality, and HAART use in Canada from 1995 to 2008.MethodsData on new HIV diagnoses were obtained from Health Canada, HIV-related mortality statistics were obtained from Statistics Canada, and information on the number of people on HAART was obtained from the single antiretroviral distribution site in British Columbia (BC), and the Intercontinental Marketing Services Health for Ontario and Quebec. Trends of new HIV-positive tests were assessed using Spearman rank correlations and the association between the number of individuals on HAART and new HIV diagnoses were estimated using generalized estimating equations (GEE).ResultsA total of 34,502 new HIV diagnoses were observed. Rates of death in BC are higher than those in Ontario and Quebec with the rate being 2.03 versus 1.06 and 1.21 per 100,000 population, respectively. The number of HIV infected individuals on HAART increased from 5,091 in 1996 to 20,481 in 2008 in the three provinces (4 fold increase). BC was the only province with a statistically significant decrease (trend test p<0.0001) in the rate of new HIV diagnoses from 18.05 to 7.94 new diagnoses per 100,000 population. Our analysis showed that for each 10% increment in HAART coverage the rate of new HIV diagnoses decreased by 8% (95% CI: 2.4%, 13.3%)InterpretationExcept for British Columbia, the number of new HIV diagnoses per year has remained relatively stable across Canada over the study period. The decline in the rate of new HIV diagnoses per year may be in part attributed to the greater expansion of HAART coverage in this province.

Association between community socioeconomic position and HIV diagnosis rate among adults and adolescents in the United States, 2005 to 2009.

We examined the association between socioeconomic position (SEP) and HIV diagnosis rates in the United States and whether racial/ethnic disparities in diagnosis rates persist after control for SEP. We used cases of HIV infection among persons aged 13 years and older, diagnosed 2005 through 2009 in 37 states and reported to national HIV surveillance through June 2010, and US Census data, to examine associations between county-level SEP measures and 5-year average annual HIV diagnosis rates overall and among race/ethnicity-sex groups. The HIV diagnosis rate was significantly higher for individuals in the low-SEP tertile than for those in the high-SEP tertile (rate ratios for low- vs high-SEP tertiles range = 1.68-3.38) except for White males and Hispanic females. The SEP disparities were larger for minorities than for Whites. Racial disparities persisted after we controlled for SEP, urbanicity, and percentage of population aged 20 to 50 years, and were high in the low-SEP tertile for males and in low- and high-SEP tertiles for females. Findings support continued prioritization of HIV testing, prevention, and treatment to persons in economically deprived areas, and Blacks of all SEP levels.

A three-source capture-recapture estimate of the number of new HIV diagnoses in children in France from 2003–2006 with multiple imputation of a variable of heterogeneous catchability

BackgroundNearly all HIV infections in children worldwide are acquired through mother-to-child transmission (MTCT) during pregnancy, labour, delivery or breastfeeding. The objective of our study was to estimate the number and rate of new HIV diagnoses in children less than 13 years of age in mainland France from 2003–2006.MethodsWe performed a capture-recapture analysis based on three sources of information: the mandatory HIV case reporting (DOVIH), the French Perinatal Cohort (ANRS-EPF) and a laboratory-based surveillance of HIV (LaboVIH). The missing values of a variable of heterogeneous catchability were estimated through multiple imputation. Log-linear modelling provided estimates of the number of new HIV infections in children, taking into account dependencies between sources and variables of heterogeneous catchability.ResultsThe three sources observed 216 new HIV diagnoses after record-linkage. The number of new HIV diagnoses in children was estimated at 387 (95%CI [271–503]) from 2003–2006, among whom 60% were born abroad. The estimated rate of new HIV diagnoses in children in mainland France was 9.1 per million in 2006 and was 38 times higher in children born abroad than in those born in France. The estimated completeness of the three sources combined was 55.8% (95% CI [42.9 – 79.7]) and varied according to the source; the completeness of DOVIH (28.4%) and ANRS-EPF (26.1%) were lower than that of LaboVIH (33.3%).ConclusionOur study provided, for the first time, an estimated annual rate of new HIV diagnoses in children under 13 years old in mainland France. A more systematic HIV screening of pregnant women that is repeated during pregnancy among women likely to engage in risky behaviour is needed to optimise the prevention of MTCT. HIV screening for children who migrate from countries with high HIV prevalence to France could be recommended to facilitate early diagnosis and treatment.

Understanding of Norms Regarding Sexual Practices Among Gay Men: Literature Review

Since there is little evidence about gay community norms across the world, we reviewed published literature in this area and discuss implications for prevention and research. Eight databases were searched for articles and 16 were considered suitable for analysis. All used quantitative methodology and seven were based on a published theoretical framework. The most common theory employed by four out of the seven papers was the Theory of Reasoned Action. All papers reviewed examined norms on condom use but norms on other risk reduction practices were not explored in these papers. Seven (44 %) studies found those men who perceived strong social support from their peers, were less likely to engage in unprotected anal intercourse. This finding suggests that social support from partners and community members plays a role in shaping safe sex norms. Better understanding of norms may help to redress HIV behaviour change programmes, particularly at the time when HIV diagnoses rates are increasing in most gay communities across the world.

Social and ethical considerations in engaging American Indian and Alaska Native communities in HIV clinical research

Background American Indians and Alaska Natives (AI/AN) have the 4th highest rate of new HIV diagnoses among racial/ethnic groups and the highest mortality rate after an AIDS diagnosis (CDC, 2012), yet continue to be underrepresented in HIV clinical research trials due to historical and cultural factors. This presentation will highlight social and ethical experiences that contribute to mistrust of Western research and medicine and low involvement in HIV clinical research trials, and provide effective strategies for respectfully engaging Native communities. The presentation will also describe the Native American Engagement in HIV Clinical Research (NAEHCR) project, a pilot aimed at increasing awareness and engagement in HIV clinical research with urban Indigenous communities using a participatory framework. NAEHCR was developed in partnership between the National Native American AIDS Prevention Center and the Legacy Project. NAEHCR is currently being conducted with DAIDS-funded research sites in Seattle, USA (HVTU, ACTU) and Denver, USA (HVTU, INSIGHT).

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HIV/AIDS Among African-Born Residents in the United States

The number of African-born residents living in the United States (US) increased by more than 750% between 1980 and 2009. HIV diagnosis rates in this population are six times higher than estimated incidence in the general US population. African-immigrants with HIV are also diagnosed at later stages of infection than US-born residents, but they paradoxically have lower mortality after diagnosis. There are higher rates of HIV among women, higher rates of heterosexual transmission, and lower rates of injection-drug-use-associated transmission among African-born residents in the US relative to the general US population. Despite this distinct epidemiologic profile, surveillance reports often group African-born residents with US-born Blacks. The high rates of HIV among African-born residents in the US combined with increasing immigration and incomplete surveillance data highlight the need for more accurate epidemiologic data along with appropriate HIV service programs.

Diagnoses of HIV Infection Among Hispanics/Latinos in 40 States and Puerto Rico, 2006–2009

In the United States, Hispanics are disproportionately affected by HIV infection. However, Hispanic subgroups of varied national origin differ culturally and HIV may impact them differently. We used information on Hispanics/Latinos diagnosed with HIV during 2006-2009 in 40 states and Puerto Rico, and aged ≥13 years, reported to the Centers for Disease Control and Prevention through June 2010, to examine the distribution of disease by selected characteristics, including place of birth and place of residence at diagnosis. We used Poisson regression to calculate the estimated annual percent change in the rate of HIV diagnoses and estimated prevalence ratios of a short HIV-to-AIDS interval (AIDS diagnosis within 12 months of HIV diagnosis). Analyses were adjusted for reporting delays and missing risk factor information. During 2006-2009, HIV infection was diagnosed among 33,498 Hispanics/Latinos. From 2006 to 2009, the annual rate of diagnoses decreased among Hispanics/Latinos [estimated annual percent change = -4.3%; 95% confidence interval (CI) = -6.5 to -2.0) including men (-2.8%; 95% CI = -5.2 to -0.4) and women (-9.8%; 95% CI = -13.2 to -6.3). The rate of HIV diagnosis remained stable by place of birth but decreased among Puerto Ricans (-13.1%; 95% CI = -17.0 to -9.0). Among Hispanics/Latinos, a short HIV-to-AIDS interval was more common in nonurban areas than in urban areas. Diagnosis of HIV infection among Hispanics/Latinos decreased and HIV-to-AIDS intervals varied by place of birth and area of residence. To continue to decrease the incidence of HIV infection among Hispanics, prevention programs need to address cultural and regional differences.

A County-Level Examination of the Relationship Between HIV and Social Determinants of Health: 40 States, 2006-2008.

Background: Social determinants of health (SDH) are the social and physical factors that can influence unhealthy or risky behavior. Social determinants of health can affect the chances of acquiring an infectious disease – such as HIV – through behavioral influences and limited preventative and healthcare access. We analyzed the relationship between social determinants of health and HIV diagnosis rates to better understand the disparity in rates between different populations in the United States.Methods: Using National HIV Surveillance data and American Community Survey data at the county level, we examined the relationships between social determinants of health variables (e.g., proportion of whites, income inequality) and HIV diagnosis rates (averaged for 2006-2008) among adults and adolescents from 40 states with mature name-based HIV surveillance.Results: Analysis of data from 1,560 counties showed a significant, positive correlation between HIV diagnosis rates and income inequality (Pearson correlation coefficient ρ = 0.40) and proportion unmarried – ages >15 (ρ = 0.52). There was a significant, negative correlation between proportion of whites and rates (ρ = -0.67). Correlations were low between racespecific social determinants of health indicators and rates.Conclusions/Implications: Overall, HIV diagnosis rates increased as income inequality and the proportion unmarried increased, and rates decreased as proportion of whites increased. The data reflect the higher HIV prevalence among non-whites. Although statistical correlations were moderate, identifying and understanding these social determinants of health variables can help target prevention efforts to aid in reducing HIV diagnosis rates. Future analyses need to determine whether the higher proportion of singles reflects higher populations of gay and bisexual men.

Projected life expectancy of people with HIV according to timing of diagnosis

Effective antiretroviral therapy (ART) has contributed greatly toward survival for people with HIV, yet many remain undiagnosed until very late. Our aims were to estimate the life expectancy of an HIV-infected MSM living in a developed country with extensive access to ART and healthcare, and to assess the effect of late diagnosis on life expectancy. A stochastic computer simulation model of HIV infection and the effect of ART was used to estimate life expectancy and determine the distribution of potential lifetime outcomes of an MSM, aged 30 years, who becomes HIV positive in 2010. The effect of altering the diagnosis rate was investigated. Assuming a high rate of HIV diagnosis (median CD4 cell count at diagnosis, 432 cells/μl), projected median age at death (life expectancy) was 75.0 years. This implies 7.0 years of life were lost on average due to HIV. Cumulative risks of death by 5 and 10 years after infection were 2.3 and 5.2%, respectively. The 95% uncertainty bound for life expectancy was (68.0,77.3) years. When a low diagnosis rate was assumed (diagnosis only when symptomatic, median CD4 cell count 140 cells/μl), life expectancy was 71.5 years, implying an average 10.5 years of life lost due to HIV. If low rates of virologic failure observed in treated patients continue, predicted life expectancy is relatively high in people with HIV who can access a wide range of antiretrovirals. The greatest risk of excess mortality is due to delays in HIV diagnosis.