Opportunity Knocks: Delayed HIV Diagnoses and Missed Screening Opportunities

Background: Thirty percent of Virginia’s newly diagnosed cases of HIV are subsequently reported with an AIDS-defining condition within one year of the initial positivity, often referred to as late HIV diagnoses. Previous research indicates that adults are likely to have been HIV positive for a median of ten years prior to the development of AIDS. Visits with healthcare providers for sexual health screening represent an opportunity for diagnosis that may be missed if HIV screening is not conducted routinely in tandem with other STD-related screening.

Methods: Surveillance data on late HIV diagnoses between 2007-2011 were merged with STD test and health department clinic visit history for five years prior to the initial HIV diagnosis. Characteristics of the medical setting where the missed opportunity for diagnosis occurred as well as population characteristics were examined using binary logistic regression.

Results: There were 1,535 late HIV diagnoses between 2007-2011. Of these, 139 (9.0%) had evidence of a previous healthcare visit (without an HIV test) as indicated by at least one STD laboratory test six months to five years prior to their HIV diagnosis.  Approximately 37% were seen in a health department STD clinic, and 56% were seen by private providers.  Males and females were equally likely to have had a prior visit (OR=0.9), black patients were more likely to have had a visit than either white or Hispanic patients (OR=1.7 and 2.5, respectively).  Men who have sex with men were twice as likely to have had a visit without being screened for HIV as compared to injection drug users (OR=2.6) or high-risk heterosexuals (OR=2.4).

Conclusions: Only a small proportion of late HIV diagnoses had a potentially missed screening opportunity in the five years prior to their HIV diagnosis.  However, this group can be targeted for improved HIV screening during healthcare visits for STD-related testing.