Paper # 34|
Monitoring the Impact of Expanded HIV Testing in the District of Columbia Using Population-based HIV/AIDS Surveillance Data
Amanda Castel*1, R Samala2, A Griffin2, T West-Ojo2, A Greenberg1, N Rocha2, and S Hader2
1George Washington Univ Sch of Publ Hlth and Hlth Svcs, Washington, DC, US and 2HIV/AIDS Admin, District of Columbia Dept of Hlth, US
Background: Washington, DC has among the highest
rates of HIV/AIDS in the US with an estimated seroprevalence of 3% of the
population. In 2006, the DC Department of Health launched an initiative to
promote the implementation of routine HIV testing with improved linkage to care
throughout the city in support of the revised US Centers for Disease Control
(CDC) testing guidelines. Emphasis was placed on encouraging routine testing in
medical settings and increasing testing and linkage to medical care for newly
identified infected individuals.
Methods: Trends in the number of tests performed by Department
of Health (DOH) publicly supported sites were reviewed. In this ecologic
analysis, HIV/AIDS name-based surveillance data from 2004 to 2008 were analyzed
to assess clinical indicators at the time of HIV diagnosis, with a report of
CD4 count, percentage or a viral load used as a measure of entry into care. The
proportion of late testers, defined as those persons diagnosed with AIDS whose
HIV diagnosis occurred within 12 months of their AIDS diagnosis, was
Results: In 2004, 2006 (the start of routine testing
expansion) and 2008, the District performed approximately 19,000, 35,000, and
73,000 HIV tests, respectively, at publicly-funded sites. The number of new
diagnoses of HIV/AIDS name-based cases reported between 2004 and 2007 increased
17% from 1,093 cases to 1,280 cases; data from 2008 are still preliminary, but
include 1,037 reports to date. Sixty-two percent of cases had a first CD4
count, percentage or viral load reported within 3 months of HIV diagnosis in
2004 compared with 67% in 2008 (Chi-square for trend, p-value <0.001). The
median CD4 count among newly diagnosed cases increased 57% from 216 cells/mL in
2004 to 340 cells/mL in 2008 (Chi-square for trend, P <0.001).
Among newly diagnosed AIDS cases, the proportion of late testers decreased from
66% in 2004 to 57% in 2008 (Chi-square for trend, P =0.0018).
Conclusions: Expanded routine HIV testing in
Washington DC has been associated with increased identification of HIV/AIDS
cases, more rapid entry into care as measured by time to initial CD4 count,
percent or viral load, and earlier diagnosis as indicated by the initial CD4
count itself and the decreasing proportion of late testers among AIDS cases.
Continued surveillance will help determine whether these findings will
translate into improved clinical outcomes and reduced HIV transmission.