Milken Institute School of Public Health Poster Presentations (Marvin Center & Video)

Title

FACTORS ASSOCIATED WITH DELAYED HIV DIAGNOSES IN WASHINGTON DC, 2006-2016

Poster Number

65

Document Type

Poster

Status

Graduate Student - Masters

Abstract Category

Epidemiology and Biostatistics

Keywords

HIV/AIDS, Delayed HIV diagnosis, Infectious disease, Epidemiology

Publication Date

Spring 2018

Abstract

Background

Delayed diagnosis of HIV is a critical indicator on the HIV care continuum. Washington DC has a high burden of HIV disease and the DC Department of Health (DOH) has implemented various public health strategies to increase routine opt-out HIV testing since the number of new infections peaked in 2007. We examined delayed HIV diagnosis in DC over 11 years, the association with demographic and transmission risk factors, and clinical indicators at time of diagnosis.

Method

Reports of HIV cases diagnosed in DC residents 13 and older between January 1, 2006, and December 31, 2016, were extracted from the DC DOH Enhanced HIV/AIDS Reporting System. Cases were matched to CD4 and viral load labs to determine median CD4 at diagnosis, linkage to care, and delayed diagnosis status. For regression analysis, cases were excluded if AIDS diagnosis date or CD4 count were missing or unreported. Delayed diagnosis was defined as stage 3 diagnosis within 90 days of the HIV diagnosis. Covariates assessed were year of diagnosis, gender, race/ethnicity, mode of transmission and age at diagnosis. Cochran-Armitage/Cuzick’s test of trend and Chi-square were used for univariate analyses. The multivariable log-binomial regression was modeled, and we reported adjusted prevalence ratios (aPR).

Results

8518 DC residents were diagnosed with HIV between 2006 and 2016. Age at diagnosis and proportion of delayed diagnoses significantly decreased over time while there were increasing trends in median CD4 count and proportion of cases linked to care within 30/90 days. In the regression analysis, 581 were excluded due to missing data, resulting in 7937 eligible for analysis. 2198 (27.7%) had a delayed diagnosis and it declined from 2006 (36.5%) to 2016 (25.5%). Black or Hispanic/Latino (vs. White, aPR 1.36 and 1.42, respectively) and persons with other/unknown mode of transmission (vs. heterosexual, 1.17) increased the prevalence of delayed diagnosis. Female (vs. male, aPR 0.81), MSM (vs heterosexual, aPR 0.80), ages 13-39 at diagnosis (vs. ages 60 and older, aPR range 0.43 to 0.83), and later year of HIV diagnosis (aPR for each 1 year increase beyond 2006 was 0.97) were less likely to have delayed diagnosis.

Conclusion

Delayed HIV diagnoses decreased from 2006 to 2016 after adjusting for demographic factors, indicating that over the analysis time period, people were diagnosed with HIV earlier in the disease course. The results suggest a need for better risk assessment and more targeted HIV testing among the populations identified to optimize health outcomes.

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FACTORS ASSOCIATED WITH DELAYED HIV DIAGNOSES IN WASHINGTON DC, 2006-2016

Background

Delayed diagnosis of HIV is a critical indicator on the HIV care continuum. Washington DC has a high burden of HIV disease and the DC Department of Health (DOH) has implemented various public health strategies to increase routine opt-out HIV testing since the number of new infections peaked in 2007. We examined delayed HIV diagnosis in DC over 11 years, the association with demographic and transmission risk factors, and clinical indicators at time of diagnosis.

Method

Reports of HIV cases diagnosed in DC residents 13 and older between January 1, 2006, and December 31, 2016, were extracted from the DC DOH Enhanced HIV/AIDS Reporting System. Cases were matched to CD4 and viral load labs to determine median CD4 at diagnosis, linkage to care, and delayed diagnosis status. For regression analysis, cases were excluded if AIDS diagnosis date or CD4 count were missing or unreported. Delayed diagnosis was defined as stage 3 diagnosis within 90 days of the HIV diagnosis. Covariates assessed were year of diagnosis, gender, race/ethnicity, mode of transmission and age at diagnosis. Cochran-Armitage/Cuzick’s test of trend and Chi-square were used for univariate analyses. The multivariable log-binomial regression was modeled, and we reported adjusted prevalence ratios (aPR).

Results

8518 DC residents were diagnosed with HIV between 2006 and 2016. Age at diagnosis and proportion of delayed diagnoses significantly decreased over time while there were increasing trends in median CD4 count and proportion of cases linked to care within 30/90 days. In the regression analysis, 581 were excluded due to missing data, resulting in 7937 eligible for analysis. 2198 (27.7%) had a delayed diagnosis and it declined from 2006 (36.5%) to 2016 (25.5%). Black or Hispanic/Latino (vs. White, aPR 1.36 and 1.42, respectively) and persons with other/unknown mode of transmission (vs. heterosexual, 1.17) increased the prevalence of delayed diagnosis. Female (vs. male, aPR 0.81), MSM (vs heterosexual, aPR 0.80), ages 13-39 at diagnosis (vs. ages 60 and older, aPR range 0.43 to 0.83), and later year of HIV diagnosis (aPR for each 1 year increase beyond 2006 was 0.97) were less likely to have delayed diagnosis.

Conclusion

Delayed HIV diagnoses decreased from 2006 to 2016 after adjusting for demographic factors, indicating that over the analysis time period, people were diagnosed with HIV earlier in the disease course. The results suggest a need for better risk assessment and more targeted HIV testing among the populations identified to optimize health outcomes.