Falling through the cracks? Missed opportunities for earlier HIV diagnosis in a New York City Hospital

Nakao, Jolene H; Wiener, Dan; Newman, David H.; Sharp, Victoria L.; Egan, Daniel J.

doi:10.1177/0956462414523944

Cited by 12 publications

(7 citation statements)

References 32 publications

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“…Studies have shown that multiple missed opportunities for HIV testing are prevalent in health-care settings, particularly in primary care clinics and emergency departments. 38,39 These missed opportunities result in late diagnoses and low CD41 counts. A study conducted in a New York City hospital found that 60% of 253 newly diagnosed HIV patients had made at least one hospital visit within three years prior to diagnosis, with a median of three visits.…”

Section: Discussionmentioning

confidence: 99%

Integrating Routine HIV Testing into Family Planning Clinics That Treat Adolescents and Young Adults

2016

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Objective. Adolescents and young adults remain at high risk for new HIV infections and for unknowingly transmitting the virus to others. Yet, they have demonstrated low rates of testing due to barriers such as stigma and difficulty accessing testing services. Few existing programs have successfully integrated family planning and HIV care services to improve testing and diagnosis rates among young adults and adolescents, particularly those of minority groups. This study describes the process of implementing HIV services into family planning clinics and how to train staff in routine, opt-out testing.Methods. This study used HIV screening data from 10 family planning clinics serving adolescents and young adults in Houston, Texas. A total of 34,299 patients were tested for HIV during a 48-month study period, from January 2010 through December 2014.Results. Patients tested included minors ,18 years of age (25.5%), males (22.8%), and individuals who had missed opportunities for HIV testing at other health-care settings. From the opt-in period (2006)(2007) to the routine, opt-out period (2008)(2009)(2010), the yearly average number of tests administered more than doubled; the yearly average increased again by 50% from the routine, opt-out period to the routine, rapid period (2011)(2012)(2013)(2014). Eighty-eight (0.3%) patients were diagnosed with HIV, a higher seropositivity rate than CDC's recommended threshold of 0.1% for settings where routine screening is warranted.Conclusion. Routine, opt-out HIV testing integrated into family planning clinics increased rates of testing acceptance, receipt of test results, and HIV-positive diagnoses among adolescents and young adults.

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Section: Discussionmentioning

confidence: 99%

Integrating Routine HIV Testing into Family Planning Clinics That Treat Adolescents and Young Adults

2016

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“…This finding was established among reported partners whose HIV status was considered unknown or seronegative; the group that the local HIV program targets for HIV testing of partners. The limited identification of HIV-free partners and of undiagnosed HIV individuals imply missed opportunities for active HIV prevention [ 19 , 21 ] and for controlling morbidity rates of HIV among PLWH expected to be earlier diagnosed [ 22 – 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Such IC visits were related to pregnancy care, hospital admissions or routine care for HAART treatment, thus pointing to missed opportunities across health services offered at the study center. At a time when care of PLWH involves an increasing number of health services, strategic HIV prevention should be fostered beyond HIV programs involving key health services, particularly for the pool of individuals at high-risk, such as partners of PLWH [ 19 , 21 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding clinical characteristics of interest, late testers were PLWH whose CD4 count was < 200 cell/mm 3 within the first 100 days [ 19 ], and linkage to care was defined as a medical visit to the Infectious Diseases (ID) outpatient service within the first 30 days [ 20 ]. The hospital admission rate corresponded to the proportion of subjects with at least one admission per person-year during the study period.…”

Section: Methodsmentioning

confidence: 99%

“…The hospital admission rate corresponded to the proportion of subjects with at least one admission per person-year during the study period. HAART eligibility at enrollment was based on the CD4 counts after diagnosis, according to the criteria in the national guidelines which changed over time: <200 cell/mm 3 between 2005 and 2012 [ 14 , 16 ] and <350 cell/mm 3 since 2012 [ 19 ]. Viral suppression was defined as a viral load <400 copies/mL at least six months after initiating HAART [ 14 – 16 ].…”

Section: Methodsmentioning

confidence: 99%

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Missed opportunities for HIV control: Gaps in HIV testing for partners of people living with HIV in Lima, Peru

et al. 2017

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IntroductionBased on the hypothesis that HIV programs struggle to deliver health services that harmonize necessities of treatment and prevention, we described the outcomes of routinely provided HIV testing to partners of people living with HIV (PLWH) through a secondary analysis of routine data collected at a public hospital in Lima, Peru.MethodsAmong PLWH enrolled in the study center’s HIV program between 2005 and 2014, we identified index cases (IC): PLWH who reported a unique partner not previously enrolled. We grouped partners according to their HIV status as reported by IC and collected data on HIV testing, clinical characteristics and admissions. The main outcome was the frequency of HIV testing among partners with reported unknown/seronegative HIV status.ResultsOut of 1586 PLWH who reported a unique partner at enrollment, 171 had a previously enrolled partner, leaving 1415 (89%) IC. HIV status of the partner was reported as unknown in 571 (40%), seronegative in 325 (23%) and seropositive in 519 (37%). Out of 896 partners in the unknown/seronegative group, 72 (8%) had HIV testing, 42/72 (58%) tested within three months of IC enrollment. Among the 49/72 (68%) who tested positive for HIV, 33 (67%) were enrolled in the HIV program. The proportion in WHO clinical stage IV was lower in enrolled partners compared to IC (37% vs 9%, p = 0.04). Non-tested partners (824) were likely reachable by the hospital, as 297/824 (36%) of their IC were admitted in the study center at least once, 51/243 (21%) female IC had received pregnancy care at the study center, and 401/692 (64%) of IC on antiretroviral therapy had achieved viral suppression, implying frequent visits to the hospital for pill pick-up.ConclusionIn this setting, HIV testing of partners of PLWH was suboptimal, illustrating missed opportunities for HIV control. Integration of HIV strategies in primarily clinical-oriented services is a challenging need.

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Late Diagnosis Due to Missed Opportunities and Inadequate Screening Strategies in HIV Infected Mexican Women

et al. 2016

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Late diagnosis of HIV remains a public health issue in Mexico. Most national programs target high-risk groups, not including women. More data on factors associated with late diagnosis and access to care in women are needed. In 2012-2013, Mexican women recently diagnosed with HIV were interviewed. Socio-cultural background, household-dynamics and clinical data were collected. Of 301 women, 49 % had <200 CD4 cells/mm, 8 % were illiterate, 31 % had only primary school. Physical/sexual violence was reported by 47/30 %; 75 % acquired HIV from their stable partners. Prenatal HIV screening was not offered in 61 %; 40 % attended consultation for HIV-related symptoms without being tested for HIV. Seeking medical care ≥3 times before diagnosis was associated with baseline CD4 <200 cells/mm (adjusted OR 3.74, 95 % CI 1.88-7.45, p < 0.001). There were missed opportunities during prenatal screening and when symptomatic women seeked medical care. Primary care needs to be improved and new strategies implemented for early diagnosis in women.

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Falling through the cracks? Missed opportunities for earlier HIV diagnosis in a New York City Hospital

Cited by 12 publications

References 32 publications

Integrating Routine HIV Testing into Family Planning Clinics That Treat Adolescents and Young Adults

Integrating Routine HIV Testing into Family Planning Clinics That Treat Adolescents and Young Adults

Missed opportunities for HIV control: Gaps in HIV testing for partners of people living with HIV in Lima, Peru

Late Diagnosis Due to Missed Opportunities and Inadequate Screening Strategies in HIV Infected Mexican Women

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