Provision of test results and posttest counseling at STD clinics in 24 health departments: U.S., 2007

HIV Care and Viral Load Suppression After Sexual Health Clinic Visits by Out-of-Care HIV-Positive Persons

Outcomes among people living with HIV (PLWH) in New York City (NYC) remain suboptimal. To assess the potential role of the city's sexual health clinics (SHCs) in improving HIV outcomes and reducing HIV transmission, we examined HIV care status and its correlates among HIV-positive SHC patients in NYC. Clinic electronic medical records were merged with longitudinal NYC HIV surveillance data to identify HIV-positive patients and derive their retrospective and prospective HIV care status. Evidence of HIV care and viral load suppression (VLS) after clinic visit were considered outcomes. Logistic regression models were used to assess their correlates. A third of the 1045 PLWH who visited NYC SHCs in 2012 were out of HIV care (OOC) in the 12 months preceding the clinic visit, and were less likely than those previously in HIV care (IC) to have subsequent evidence of HIV care (42% vs. 72%) or VLS in the 12 months after the visit (39% vs. 76%). VLS was particularly low among patients diagnosed with ≥2 sexually transmitted infections (46%). The odds of VLS were lowest among those OOC before the clinic visit [versus those IC, adjusted odds ratio (aOR): 0.21, 95% confidence interval (CI): 0.16-0.29], non-Hispanic blacks (versus non-Hispanic whites, aOR: 0.58, 95% CI: 0.37-0.90), and residents of high-poverty neighborhoods (>30% vs. <10%, aOR: 0.51, 95% CI: 0.29-0.89). Our findings suggest that SHCs could serve as an intervention point to (re-)link PLWH to HIV care. Real-time provider alerts about patients' OOC status could help achieve that goal.

Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

OBJECTIVES

Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP.

METHODS

We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of ≤3 foci of the article) or "minimal" (ie, one of ≥4 foci of the article).

RESULTS

Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%).

CONCLUSIONS

This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic.

Optimal allocation of HIV prevention funds for state health departments

OBJECTIVE

To estimate the optimal allocation of Centers for Disease Control and Prevention (CDC) HIV prevention funds for health departments in 52 jurisdictions, incorporating Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program funds, to improve outcomes along the HIV care continuum and prevent infections.

METHODS

Using surveillance data from 2010 to 2012 and budgetary data from 2012, we divided the 52 health departments into 5 groups varying by number of persons living with diagnosed HIV (PLWDH), median annual CDC HIV prevention budget, and median annual HRSA expenditures supporting linkage to care, retention in care, and adherence to antiretroviral therapy. Using an optimization and a Bernoulli process model, we solved for the optimal CDC prevention budget allocation for each health department group. The optimal allocation distributed the funds across prevention interventions and populations at risk for HIV to prevent the greatest number of new HIV cases annually.

RESULTS

Both the HIV prevention interventions funded by the optimal allocation of CDC HIV prevention funds and the proportions of the budget allocated were similar across health department groups, particularly those representing the large majority of PLWDH. Consistently funded interventions included testing, partner services and linkage to care and interventions for men who have sex with men (MSM). Sensitivity analyses showed that the optimal allocation shifted when there were differences in transmission category proportions and progress along the HIV care continuum.

CONCLUSION

The robustness of the results suggests that most health departments can use these analyses to guide the investment of CDC HIV prevention funds into strategies to prevent the most new cases of HIV.

HIV Testing and HIV Service Delivery to Populations at High Risk Attending Sexually Transmitted Disease Clinics in the United States, 2011-2013

OBJECTIVES

We evaluated HIV testing and service delivery in Centers for Disease Control and Prevention (CDC)-funded sexually transmitted disease (STD) clinics.

METHODS

We assessed HIV testing, HIV positivity, receipt of HIV test results, linkage to medical care, and referral services from 61 health department jurisdictions from 2011 to 2013.

RESULTS

In 2013, 18.6% (621 010) of all CDC-funded HIV-testing events were conducted in STD clinics, and 0.8% were newly identified as HIV-positive. In addition, 27.3% of all newly identified HIV-positive persons and 30.1% of all newly identified HIV-positive men who have sex with men were identified in STD clinics. Linkage to care within any time frame was 63.8%, and linkage within 90 days was 55.3%. Although there was a decrease in first-time HIV testers in STD clinics from 2011 to 2013, identification of new positives increased.

CONCLUSIONS

Although linkage to care and referral to partner services could be improved, STD clinics appear successful at serving populations disproportionately affected by HIV. These clinics may reach persons who may not otherwise seek HIV testing or medical services and provide an avenue for service provision to these populations.

The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities

Little is known about how adolescents and young adults contribute to the declines in the cascade of care from HIV-1 diagnosis to viral suppression. We reviewed published literature from the Unites States reporting primary data for youth (13-29 years of age) at each stage of the HIV cascade of care. Approximately 41% of HIV-infected youth in the United States are aware of their diagnosis, while only 62% of those diagnosed engage medical care within 12 months of diagnosis. Of the youth who initiate antiretroviral therapy, only 54% achieve viral suppression and a further 57% are not retained in care. We estimate less than 6% of HIV-infected youth in the United States remain virally suppressed. We explore the cascade of care from HIV diagnosis through viral suppression for HIV-infected adolescents and young adults in the United States to highlight areas for improvement in the poor engagement of the infected youth population.