The Southern states experience the highest rates of HIV and AIDS in the US, and point-of-care (POC) testing outside of primary care may contribute to status awareness in medically underserved populations in this region. To evaluate POC screening and linkage to care at an urban south site, analyses were performed on a dataset of 3,651 individuals from an integrated rapid-result HIV testing and linkage program to describe this test-seeking cohort and determine trends associated with screening, results, and linkage to care. Four percent of the population had positive results. We observed significant differences by test result for age, race and gender, reported risk behaviors, test location, and motivation for screening. The overall linkage rate was 86%, and we found significant differences for clients who were linked to HIV care versus persons whose linkage could not be confirmed with respect to race and gender, location, and motivation. The linkage rate for POC testing that included a comprehensive intake visit and colocated primary care services for in-state residents was 97%. Additional research on integrated POC screening and linkage methodologies that provide intake services at time of testing is essential for increasing status awareness and improving linkage to HIV care in the US. 1. Introduction Prevention and treatment of Human Immunodeficiency Virus (HIV) infection have evolved through important advances in the field, and the number of new HIV infections in the United States has steadied near 50,000 cases annually [1, 2]. However one-fifth of adults and up to one half of HIV-infected young persons in the United States (US) are not aware of their positive status [3–9]. Considering these statistics, the Centers for Disease Control and Prevention (CDC) released revised recommendations for routine HIV testing during medical visits in US primary care settings [3]; but hurdles to healthcare-based HIV testing still exist at policy, organizational, and individual levels in the Unites States and abroad [10–15]. The recommendations for widespread implementation of standardized opt-out testing in US primary care settings were revised in 2011. Draft revisions in 2013 [16, 17] may address challenges associated with inadequate healthcare, targeted screening, and inaccuracies of individual risk perception [18–20]. As approximately 20% of adults with at least one prior HIV test report a recent (within last 12 months) test in venues outside of primary care offices [14], determining the factors associated with point-of-care (POC) test seeking is an important tactic
References
[1]
CDC, HIV Counseling and Testing at CDC-Supported Sites—United States, 1999–2004, CDC, Atlanta, Ga, USA, 2006.
[2]
CDC, Demonstration Projects for Health Departments and Community-Based Organizations (CBOs): Antiretroviral Treatment Access Study (ARTAS) II: Linkage to HIV Care, CDC, 2006.
[3]
B. Branson, “Current HIV epidemiology and revised recommendations for HIV testing in health-care settings,” Journal of Medical Virology, vol. 79, supplement 1, pp. S6–S10, 2007.
[4]
A. Wurcel, T. Zaman, S. Zhen, and D. Stone, “Acceptance of HIV antibody testing among inpatients and outpatients at a public health hospital: a study of rapid versus standard testing,” AIDS Patient Care and STDs, vol. 19, no. 8, pp. 499–505, 2005.
[5]
“Vital signs: HIV infection, testing, and risk behaviors among youths—United States,” Morbidity and Mortality Weekly Report, pp. 971–976, 2012.
[6]
H. F. Raymond, T. Bingham, and W. McFarland, “Locating unrecognized HIV infections among men who have sex with men: San Francisco and Los Angeles,” AIDS Education and Prevention, vol. 20, no. 5, pp. 408–419, 2008.
[7]
R. P. Walensky, E. Losina, K. A. Steger-Craven, and K. A. Freedberg, “Identifying undiagnosed human immunodeficiency virus: the yield of routine, voluntary inpatient testing,” Archives of Internal Medicine, vol. 162, no. 8, pp. 887–892, 2002.
[8]
M. L. Campsmith, P. H. Rhodes, I. Hall, and T. A. Green, “Undiagnosed HIV prevalence among adults and adolescents in the United States at the end of 2006,” Journal of Acquired Immune Deficiency Syndromes, vol. 53, no. 1, pp. 619–624, 2010.
[9]
M. Chen, P. H. Rhodes, I. H. Hall, et al., “Prevalence of undiagnosed HIV infection among persons aged 13 years—National HIV Surveillance System, United States, 2005–2008,” Morbidity and Mortality Weekly Report, vol. 61, supplement, pp. 57–64, 2012.
[10]
L. Peralta, B. G. Deeds, S. Hipszer, and K. Ghalib, “Barriers and facilitators to adolescent HIV testing,” AIDS Patient Care and STDs, vol. 21, no. 6, pp. 400–408, 2007.
[11]
S. A. Rizza, R. J. MacGowan, D. W. Purcell, B. M. Branson, and Z. Temesgen, “HIV screening in the health care setting: status, barriers, and potential solutions,” Mayo Clinic Proceedings, vol. 87, pp. 915–924, 2012.
[12]
S. Schwarcz, T. A. Richards, H. Frank et al., “Identifying barriers to HIV testing: personal and contextual factors associated with late HIV testing,” AIDS Care, vol. 23, no. 7, pp. 892–900, 2011.
[13]
N. P. Pai, C. Vadnais, C. Denkinger, N. Engel, and M. Pai, “Point-of-care testing for infectious diseases: diversity, complexity, and barriers in low- and middle-income countries,” PLOS Medicine, vol. 9, Article ID e1001306, 2012.
[14]
CDC, HIV Testing Trends in the United States, 2000-2011, CDC, Atlanta, Ga, USA, 2013.
[15]
C. Hanssens, “Legal and ethical implications of opt-out HIV testing,” Clinical Infectious Diseases, vol. 45, supplement 4, pp. S232–S239, 2007.
[16]
R. Bayer and G. M. Oppenheimer, “Routine HIV testing, public health, and the USPSTF—an end to the debate,” The New England Journal of Medicine, vol. 368, pp. 881–884, 2013.
[17]
E. G. Martin and B. R. Schackman, “Updating the HIV-testing guidelines—a modest change with major consequences,” The New England Journal of Medicine, vol. 368, pp. 884–886, 2013.
[18]
A. P. Mahajan, L. Stemple, M. F. Shapiro, J. B. King, and W. E. Cunningham, “Consistency of state statutes with the centers for disease control and prevention HIV testing recommendations for health care settings,” Annals of Internal Medicine, vol. 150, no. 4, pp. 263–269, 2009.
[19]
A. Qaseem, V. Snow, P. Shekelle, R. Hopkins Jr., and D. K. Owens, “Screening for HIV in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association,” Annals of Internal Medicine, vol. 150, no. 2, pp. 125–131, 2009.
[20]
L. A. Kennedy, F. M. Gordin, and V. L. Kan, “Assessing targeted screening and low rates of HIV testing,” American Journal of Public Health, vol. 100, no. 9, pp. 1765–1768, 2010.
[21]
R. S. Janssen, D. R. Holtgrave, R. O. Valdiserri, M. Shepherd, H. D. Gayle, and K. M. De Cock, “The serostatus approach to fighting the HIV epidemic: prevention strategies for infected individuals,” American Journal of Public Health, vol. 91, no. 7, pp. 1019–1024, 2001.
CDC, Quality Assurance Guidelines for Testing Using Rapid HIV Antibody Tests Waived Under the Clinical Laboratory Improvement Amendments of 1988, CDC, 2007.
[24]
J. D. O'Neal, M. R. Golden, B. M. Branson, and J. D. Stekler, “HIV nucleic acid amplification testing versus rapid testing: it is worth the wait. Testing preferences of men who have sex with men,” Journal of Acquired Immune Deficiency Syndromes, vol. 60, pp. e117–e120, 2012.
[25]
Office of National AIDS Policy, National HIV/AIDS Strategy, The White House, Washington, DC, USA, 2010.
[26]
S. D. Pinkerton and C. L. Galletly, “Reducing HIV transmission risk by increasing serostatus disclosure: a mathematical modeling analysis,” AIDS and Behavior, vol. 11, no. 5, pp. 698–705, 2007.
[27]
A. K. Sullivan, H. Curtis, C. A. Sabin, and M. A. Johnson, “Newly diagnosed HIV infections: review in UK and Ireland,” British Medical Journal, vol. 330, no. 7503, pp. 1301–1302, 2005.
[28]
G. Marks, N. Crepaz, J. W. Senterfitt, and R. S. Janssen, “Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs,” Journal of Acquired Immune Deficiency Syndromes, vol. 39, no. 4, pp. 446–453, 2005.
[29]
L. S. Weinhardt, “Effects of a detailed sexual behavior interview on perceived risk of HIV infection: preliminary experimental analysis in a high risk sample,” Journal of Behavioral Medicine, vol. 25, no. 2, pp. 195–203, 2002.
[30]
R. P. Walensky, A. D. Paltiel, E. Losina, et al., “Test and treat DC: forecasting the impact of a comprehensive HIV strategy in Washington DC,” Clinical Infectious Diseases, vol. 51, pp. 392–400, 2010.
[31]
R. P. Walensky and I. V. Bassett, “HIV self-testing and the missing linkage,” PLoS Medicine, vol. 8, no. 10, Article ID e1001101, 2011.
[32]
C. Gopalappa, P. G. Farnham, A. B. Hutchinson, and S. L. Sansom, “Cost effectiveness of the National HIV/AIDS Strategy goal of increasing linkage to care for HIV-infected persons,” Journal of Acquired Immune Deficiency Syndromes, vol. 61, pp. 99–105, 2012.
[33]
J. Bertolli, R. L. Shouse, L. Beer, et al., “Using HIV surveillance data to monitor missed opportunities for linkage and engagement in HIV medical care,” The Open AIDS Journal, vol. 6, pp. 131–141, 2012.
[34]
W. E. Norton, “An exploratory study to examine intentions to adopt an evidence-based HIV linkage-to-care intervention among state health department AIDS directors in the United States,” Implementation Science, vol. 7, article 27, 2012.
[35]
A. Zinski, Who is in a hurry for HIV test results? An exploration of presentation for Oraquick rapid result HIV antibody testing in urban clinical and outreach settings in Alabama. Dissertation Abstracts International: Section B: The Sciences and Engineering, ProQuest International, 2008.
[36]
K. Glanz, B. Rimer, and F. Lewis, Health Behavior and Health Education: Theory, Research, and Practice, Wiley & Sons, San Francisco, 2002.
[37]
R. Wylie, M. Marler, H. Lin, et al., “Project CONNECT: overcoming barriers to establishing HIV care,” in Proceedings of the 4th International Conference on HIV Treatment Adherence, Miami, Fla, USA, 2009,.
[38]
D. S. Batey, S. T. Lawrence, N. C. Godwin, et al., “Psychosocial symptom differences among new patient groups at an HIV medical clinic: project CONNECT,” in Society for Social Work and Research 14th Annual Conference, San Francisco, Ca, USA, 2010.
[39]
Q. An, J. Prejean, and H. I. Hall, “Racial disparity in U.S. Diagnoses of acquired immune deficiency syndrome, 2000–2009,” American Journal of Preventive Medicine, vol. 43, pp. 461–466, 2012.
[40]
T. A. Farley, “Sexually transmitted diseases in the Southeastern United States: location, race, and social context,” Sexually Transmitted Diseases, vol. 33, no. 7, pp. S58–S64, 2006.
[41]
V. Fuqua, Y.-H. Chen, T. Packer et al., “Using social networks to reach Black MSM for HIV testing and linkage to care,” AIDS and Behavior, vol. 16, no. 2, pp. 256–265, 2012.
[42]
N. T. Harawa, M. Leng, J. Kim, and W. E. Cunningham, “Racial/ethnic and gender differences among older adults in nonmonogamous partnerships, time spent single, and human immunodeficiency virus testing,” Sexually Transmitted Diseases, vol. 38, no. 12, pp. 1110–1117, 2011.
[43]
W. A. Hill and C. McNeely, “HIV/AIDS disparity between African-American and caucasian men who have sex with men: intervention strategies for the black church,” Journal of Religion and Health, vol. 52, no. 2, pp. 475–487, 2011.
[44]
US Department of Commerce, “Jefferson County QuickFacts from the US Census Bureau,” in State and County QuickFacts. Data Derived From Population Estimates, American Community Survey, Census of Population and Housing, State and County Housing Unit Estimates, County Business Patterns, Nonemployer Statistics, Economic Census, Survey of Business Owners, Building Permits, Consolidated Federal Funds Report, US Census Bureau, 2013.
[45]
N. Harawa and A. Adimora, “Incarceration, African Americans and HIV: advancing a research agenda,” Journal of the National Medical Association, vol. 100, no. 1, pp. 57–62, 2008.
[46]
D. Stratford, Y. Mizuno, K. Williams, C. Courtenay-Quirk, and A. O'Leary, “Addressing poverty as risk for disease: recommendations from CDC's consultation on microenterprise as HIV prevention,” Public Health Reports, vol. 123, no. 1, pp. 9–20, 2008.
[47]
M. Fisher, “Late diagnosis of HIV infection: major consequences and missed opportunities,” Current Opinion in Infectious Diseases, vol. 21, no. 1, pp. 1–3, 2008.
[48]
E. Girardi, C. A. Sabin, and A. D. Monforte, “Late diagnosis of HIV infection: epidemiological features, consequences and strategies to encourage earlier testing,” Journal of Acquired Immune Deficiency Syndromes, vol. 46, supplement 1, pp. S3–S8, 2007.
[49]
S. Schwarcz, L. Hsu, J. W. Dilley, L. Loeb, K. Nelson, and S. Boyd, “Late diagnosis of HIV infection: trends, prevalence, and characteristics of persons whose HIV diagnosis occurred within 12 months of developing AIDS,” Journal of Acquired Immune Deficiency Syndromes, vol. 43, no. 4, pp. 491–494, 2006.
[50]
W. M. El-Sadr, T. R. Gamble, and M. S. Cohen, “Linkage from HIV testing to care: a positive test often leads nowhere,” Sexually Transmitted Diseases, vol. 40, pp. 26–27, 2013.
[51]
S. S. Johnston, T. Juday, D. Seekins, et al., “Patterns and correlates of linkage to appropriate HIV care after HIV diagnosis in the US Medicaid population,” Sexually Transmitted Diseases, vol. 40, pp. 18–25, 2013.
[52]
N. M. Zetola, K. Bernstein, K. Ahrens et al., “Using surveillance data to monitor entry into care of newly diagnosed HIV-infected persons: San Francisco, 2006-2007,” BMC Public Health, vol. 9, article 17, 2009.
[53]
N. P. Pai and M. Pai, “Point-of-care diagnostics for HIV and tuberculosis: landscape, pipeline, and unmet needs,” Discovery Medicine, vol. 13, pp. 35–45, 2012.
[54]
N. P. Pai, B. Balram, S. Shivkumar et al., “Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis,” The Lancet Infectious Diseases, vol. 12, no. 5, pp. 373–380, 2012.
[55]
M. Schito, T. F. Peter, S. Cavanaugh et al., “Opportunities and challenges for cost-efficient implementation of new point-of-care diagnostics for HIV and tuberculosis,” Journal of Infectious Diseases, vol. 205, supplement 2, pp. S169–S180, 2012.
[56]
M. S. Cohen, Y. Q. Chen, M. McCauley, et al., “Prevention of HIV-1 infection with early antiretroviral therapy,” The New England Journal of Medicine, vol. 365, pp. 493–505, 2011.
[57]
J. A. Fleishman, B. R. Yehia, R. D. Moore, and K. A. Gebo, “The economic burden of late entry into medical care for patients with HIV infection,” Medical Care, vol. 48, no. 12, pp. 1071–1079, 2010.
[58]
C. S. Krawczyk, E. Funkhouser, J. M. Kilby, and S. H. Vermund, “Delayed access to HIV diagnosis and care: special concerns for the Southern United States,” AIDS Care, vol. 18, 1, pp. S35–S44, 2006.
