Expanded HIV testing coverage is associated with decreases in late HIV diagnoses

Abstract

Objective Expanded HIV testing coverage could result in earlier diagnosis of HIV, along with reduced morbidity, mortality, and onward HIV transmission. Design Longitudinal analysis of aggregate, population-based surveillance data within New York City (NYC) ZIP codes. Methods We examined new HIV diagnoses and recent HIV testing to examine whether changes in recent HIV testing coverage (last 12 months) were associated with changes in late HIV diagnosis rates within NYC ZIP codes during 2003–2010, a period of expansion of HIV testing in NYC. Results Overall, recent HIV testing coverage increased from 23% to 31% during 2003–2010, while the rate of late HIV diagnoses decreased from 14.9 per 100,000 to 10.6 per 100,000 population. Within ZIP codes, each 10% absolute increase in recent HIV testing coverage was associated with a 2.5 per 100,000 absolute decrease in the late HIV diagnosis rate. ZIP codes with the largest changes in HIV testing coverage among men were more likely to have the largest (top quartile) declines in late HIV diagnosis rates among men (adjusted odds ratio [aOR]men=4.0; 95%CI=1.5–10.8), as compared with ZIP codes with no or small changes in HIV testing coverage. However, this association was not significant for women (aORwomen=1.4 95% CI=0.50–4.3). Significant geographic disparities in late HIV diagnosis rates persisted in 2009/10. Conclusions Increases in recent HIV testing coverage may have reduced late HIV diagnoses among men. Persistent geographic disparities underscore the need for continued expansion of HIV testing to promote earlier HIV diagnosis.

Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing

“…Neighborhood HIV testing accessibility was a statistically significant predictor of late HIV diagnosis for men but not women. The non-significant finding among women could be related to HIV testing being more normative for women given universal HIV screening during pregnancy (Ransome et al, 2015). Alternately, within neighborhoods, women may be less likely than men to receive and benefit from advances in HIV prevention technologies (West et al, 2015).…”

“…New York City (NYC) is the study setting because the city has high income inequality (New York City Comptroller and Liu, 2012), high black racial concentration (Alba and Romalewski, 2012), and high prevalence (22%) (AIDSvu, 2016) and rate (10.65 per 100,000 persons) of late HIV diagnosis (Ransome et al, 2015). The units of analysis are ZIP codes because, in NYC, this unit approximates neighborhoods well (Silver and Messeri, 2014).…”

“…In fact, currently, the Centers for Disease Control and Prevention (CDC) recommend screening for everyone in the population as routine part of their health care at least once a year (Centers for Disease Control and Prevention, 2010). Empirical studies showed that expanded HIV testing activities are associated with increases in identifying number of HIV-infected persons unaware of their HIV status (Centers for Disease Control and Prevention, 2011), decreases in rates of late HIV diagnosis in the population (Ransome et al, 2015), and more timely entry into HIV care (Castel et al, 2013). HIV testing and HIV testing accessibility are along the pathway between upstream socioeconomic and structural determinants and HIV infection (Pellowski et al, 2013) and transmission in the population (Poundstone et al, 2004).…”

Foreign-born status as a predictor of engagement in HIV care in a large US metropolitan health system

“…We suspect that even prior to entering our healthcare system, unequal barriers to HIV testing due to perceived need, stigma, fear of deportation, and lack of a regular health care provider, may have contributed to the disparity in baseline disease severity (De Jesus, Carrete, Maine, & Nalls, 2015; Hacker et al, 2011; Levy et al, 2007; Ojikutu, Nnaji, Sithole-Berk, Bogart, & Gona, 2014; Ransome et al, 2015). While US Immigration and Customs Enforcement detention facilities house nearly 32,000 immigrants per day, HIV screening is not routine (Martinez-Donate et al, 2015; Venters, McNeely, & Keller, 2009).…”

The Current HIV/AIDS Prevention Strategies—Widely Outsmarted by Omitting Realities: A Socio-Critical Analysis in the Context of Powerless Law, Ethics and Asymmetric Interpretation of Human Rights

“…It represents a measure that aims to overcome most, if not all, of the barriers to HIV testing-"… a long-overdue acknowledgement of the evidence as interpreted by the CDC …" [14]. This has to be seen also in the context to reduce the number of "HIV late presenters" [15]- [17]. The initiative of the USPSTF is to be seen as targeting "at-risk" people who are unaware of their HIV-positive status because they either do not like or fear the knowledge that they are HIV-infected.…”