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Background: Lack of HIV viral suppression and STD infection in PLWH increase the risk of HIV transmission. In 2014, 44% of diagnosed Californian PLWH were not virally suppressed. Re-engaging STD co-infected PLWH in care presents an opportunity to improve viral suppression and decrease transmission. We examined the impact of an STD diagnosis on re-engagement in care in co-infected PLWH.
Methods: Persons diagnosed with any bacterial STD (chlamydia, gonorrhea, or early syphilis) in 2014 were matched to HIV surveillance data using a probabilistic algorithm. HIV lab data (CD4, viral load, or genotype) reported for the year prior to first STD diagnosis in 2014 were used to classify in-care status (≥1 HIV test in the prior year) and viral suppression (most recent viral load ≤200). For persons out-of-care, HIV lab data reported between date of STD diagnosis and 12/31/2015 were examined to identify re-engagement in care.
Results: In 2014, there were 124,694 diagnosed PLWH in California; 8,171 (6.6%) were co-infected with ≥1 STD. Among those co-infected, 7,380 (90.3%) were in-care and 791 (9.7%) were out-of-care at the time of STD diagnosis; 5,586 (68.4%) were virally suppressed, 1,575 (19.3%) were not, and 1,010 (12.4%) had no reported viral load. Among persons out-of-care, 289 (36.5%) did not have any HIV care visits after STD diagnosis, 218 (27.6%) had a care visit in ≤90 days, and 284 (35.9%) had a care visit in >90 days.
Conclusions: Rates of STD co-infection were low and the proportion of co-infected PLWH in care was high. The majority of out-of-care co-infected PLWH became re-engaged in care after STD diagnosis, suggesting that STD diagnoses are an opportunity to successfully re-engage this population in care. Successful re-engagement in care for STD co-infected PLWH can enhance efforts to close gaps in the HIV care continuum. STD/HIV case matching can be useful for predicting program impact.