Most People With HIV Know Status; More Testing Still Needed

Beth Skwarecki

July 03, 2015

Five states (Colorado, Connecticut, Delaware, Hawaii, and New York) have achieved the National HIV/AIDS Strategy objective of informing at least 90% of people with HIV of their status, according to estimates in an article published in the June 26 issue of the Morbidity and Mortality Weekly Report.

"The results presented in this report show that although the overall percentage of persons living with HIV who have received a diagnosis of HIV infection is high, additional efforts are needed to ensure that all jurisdictions meet the goals of the strategy," write H. Irene Hall, PhD, from the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues. Those efforts include reducing the incidence of HIV, improving health outcomes for people with the virus, and reducing HIV-related health disparities.

According to the analysis, which covered the years 2008 to 2012, Louisiana had the lowest percentage of HIV-positive patients who knew their status, at 77%. Among men who have sex with men, who make up 60% of new HIV diagnoses, the percentage who knew their serostatus was 75% in Louisiana, with only two states, Hawaii and New York, hitting 90%.

Overall prevalence of HIV also varied geographically. Among the 42 jurisdictions with estimates that were considered to be numerically stable (those with very small numbers of people with HIV were excluded), the lowest rate was 110 per 100,000 individuals in Iowa, and the highest was 3936 in the District of Columbia. New York had the next highest prevalence, with 1070 per 100,000.

June 27 is National HIV Testing Day. Patients with HIV who begin treatment earlier benefit from greater quality of life and longer survival. Appropriate treatment and monitoring also reduce their risk of transmitting the virus to others.

The Centers for Disease Control and Prevention recommends routine HIV testing for people aged 13 to 64 years in high-risk groups and in areas where the prevalence of HIV is 0.1% of the population or greater. A second article in the Morbidity and Mortality Weekly Report analyzed the number of HIV tests and diagnoses at 23 different types of testing sites in 2013. The sites ranged from healthcare settings such as emergency departments and women's health clinics to schools, shelters, and homes.

The percentage of new positive tests ranged from 0.2% to 0.8%, and among healthcare settings, the percentage was highest in sexually transmitted disease clinics (0.8%), unspecified outpatient facilities (0.5%), substance abuse treatment facilities (0.4%), and HIV clinics (0.4%).

Outside of healthcare settings, the percentage ranged from 0.2% to 1.3% and was highest in field tests of partners of HIV-positive people (1.3%), bars (1.2%), individual residences (1.1%), and HIV counseling sites (1.0%). Overall, new positives ranged from 0.2% to 2.3% among blacks, 0.1% to 1.3% among Hispanics, and 0.6% to 5.8% among men who have sex with men.

Although the study aimed to calculate the percentage of HIV-positive persons linked to care, estimates ranged widely: overall, between 49.1% and 86.5% were linked to care within 90 days. None of the sites met the goal of 85% linkage, using the minimum numbers. Using maximum numbers, eight of the 12 healthcare sites and seven of the 11 nonhealthcare sites met the goal.

Each type of testing site has its advantages: "Although testing in non–health care settings identified a higher percentage of new positives, such testing often is more expensive per test than testing in health care settings and might not target all hard-to-reach populations. Conversely, health care settings, which offer more efficient methods of testing and linkage, might miss undiagnosed HIV-positive persons who do not access health care," write Puja Seth, PhD, from the Centers for Disease Control and Prevention's Division of HIV/AIDS Prevention and colleagues.

"Focusing HIV testing efforts on the most effective sites in both health care and non–health care settings and increasing linkage to medical care could have a large impact on identifying new positives and ensuring that they receive recommended services," they conclude.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015;64:657-662. Hall full text, Seth full text


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