September 6, 2012
Julie E. Myers et al. J Acquir Immune Defic Syndr 2012;61:23-31. Read the abstract.
The first bar on the HIV continuum of care that Ed Gardner and colleagues first formulated starts with those who do and do not know they are HIV infected. (Not familiar with it? Google it and study it carefully.) An estimated 20% to 25% of all infected persons in the U.S. are unaware they harbor the virus. To get to the last bar, the proportion of HIV-infected Americans with suppressed virus, you need to start with detection. A major effort to enhance testing has been underway in several places, most notably Washington, D.C., and the Bronx, where the prevalence of HIV is high.
In New York City, over 110,000 people are living with HIV -- that is 10% of all those who are HIV infected in the country -- and many live in the outer boroughs, including the Bronx (where prevalence is around 1.8%). In response, the city launched the Bronx Knows HIV testing campaign. A combination of social marketing and resource allocation to support testing and linkage to care, the program aims to test each and every Bronx resident who has not been previously tested.
To get an early sense of the success of the program, initiated in 2008, Myers and colleagues examined rates of self-reported HIV testing among respondents to a phone health survey. The survey is automated and randomly calls 10,000 New Yorkers each year and includes questions regarding HIV testing. Comparing 2005 and 2009 data, the researchers found that rates of ever testing for HIV among respondents in the Bronx increased 14%, from 69% to 79% (P < .001). Testing during the past year also increased significantly.
The most significant increases (20%-50% increases) were noted among those aged 24-44 years, men, non-Hispanic blacks, Hispanics, those with an annual household income of less than 200% of the federal poverty level, those with less than a high school education, those with a heterosexual or bisexual identity, those with a primary care provider, and those with health insurance. The testing rate went down in only one group, whites. However, in a multivariable analysis, being non-white, having insurance and identifying as bisexual were the only factors independently associated with 12 month HIV testing.
In a rough test of the effect of the program on reducing delays in HIV diagnosis, the team also looked at surveillance data to compare rates of reported AIDS in 2005 to 2009, after the launch of the program. The proportion of all reported AIDS cases in the city from the Bronx fell from 30% to 23% and was even greater for certain groups, such as those older than 45 years of age and heterosexuals. These results appear to support the effectiveness of the testing program, and even more impressive results have been reported from D.C. The study also points to groups requiring greater attention (i.e., whites, MSM, young people, and the under-insured).
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