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Background: We implemented a routine, opt-out rapid HIV testing program at a large LGBT health center in Chicago. Medical Assistants conducted testing and were prompted by an electronic health records system (EHRS) that screened for testing eligibility (13-64 years old, HIV negative, and no documented test within 12 months).
Methods: We extracted demographic and clinical data from January-October 2013 to characterize new diagnoses of HIV infections. We also conducted a case review to assess linkage-to-care and clinical management.
Results: 1199/1326 (90.4%) consented to testing. There were ten new HIV diagnoses – yielding a 0.83% positivity rate. Patients testing positive were 30% Black, 20% Hispanic-Black, 30% Hispanic, and 20% White. Newly HIV-positive patients included four transwomen and six cisgender-men; all reported having sex with men as their primary HIV risk. Median age for patients was: 22 years (IQR=21-24) for newly diagnosed and 32 years (IQR=26-43) for the sample (p<0.05). Chief complaints at presentation included: hormone access (n=4), STI symptoms/concerns (n=3), and general health (n=3). Half of the newly diagnosed were established patients (at least four visits in last five years) and 4/5 had been tested within two years. At diagnosis, medical visits were completed and CD4/VL labs drawn. Engagement outcomes were six patients in care (two appointments; >two months apart), one lost to follow-up, one transfer, and two exclusions (<2 month follow-up period). Patients in-care (n=6) were virally suppressed three months post-diagnosis (median=130 copies/mL).
Conclusions: Initiation of a routine opt-out HIV testing program identified ten newly diagnosed patients. On-site linkage staff ensured new HIV patients had access to clinical interventions. Compared to those testing negative, newly diagnosed patients were more likely to be younger and racially/ethnically diverse. Since many of the newly HIV-positive were tested within two years, these data affirm the need for more frequent screening to identify recent HIV infections.