![[ Visit Client Website ]](images/banner.gif)
Background: In 2012, 1,522 HIV-positive and approximately 12,000 patients with unknown HIV status attended New York City (NYC) STD clinics, where opt-out HIV testing is performed. We measured HIV care outcomes and quantified gaps in care.
Methods: All patients testing HIV-positive and those with a previous HIV diagnosis, and a 10% random sample (n=1,196) of patients with unknown status on day of clinic visit (DOV) were matched against the NYC HIV Registry (HARS). Using HARS diagnosis dates, we determined HIV status of matched patients as “new-positives” (newly diagnosed on DOV), “known-positives” (diagnosed >90 days before DOV), and “unknown-positives” (previously diagnosed, but unknown status on DOV). Using HARS laboratory data through 2013, we assessed whether patients were: 1) “linked to care” (test results within 3 months for new-positives); 2) “re-linked to care” (for out-of-care patients); 3) “in HIV care” (>2 laboratory test results >90 days apart in year preceding DOV); 4) subsequently “virally suppressed” (viral load (VL)<200 copies/mL within year after DOV).
Results: Most patients (95%; 1,472/1,552) diagnosed with HIV on/before DOV matched to HARS; 5% (63/1,196) with unknown status matched, signifying that ~630 additional HIV-positive patients attended STD clinics. Of new-positives, 65% (227/351) were linked to care. Of 1,121 known-positives, 66% (740/1,121) were in care. Of the remaining 381 out-of-care known-positives, 44% (166/381) were re-linked. Of 63 unknown-positives, 40% (25/63) were in care; of the remaining out-of-care unknown-positives, 21% (8/38) re-linked. Viral suppression was documented for: 88% (22/25) of in-care unknown-positives, 76% (559/740) of in-care known-positives, 50% (176/351) of new-positives, 42% (158/381) of out-of-care known-positives, and 16% (6/38) of out-of-care unknown-positives.
Conclusions: Large numbers of HIV-positive persons, including many whose HIV status is unknown, attend NYC STD clinics (~2,200/year). Opportunities for linkage/re-linkage could be facilitated by real-time ascertainment of HIV status using the HIV registry.