Temporal association between expanded HIV testing and improvements in population-based HIV/AIDS clinical outcomes, District of Columbia

Abstract

In 2006, the District of Columbia Department of Health (DC DOH) launched initiatives promoting routine HIV testing and improved linkage to care in support of revised the Centers for Disease Control and Prevention (CDC) HIV-testing guidelines. An ecological analysis was conducted using population-based surveillance data to determine whether these efforts were temporally associated with increased and earlier identification of HIV/AIDS cases and improved linkages to care. Publically funded HIV-testing data and HIV/AIDS surveillance data from 2005 to 2009 were used to measure the number of persons tested, new diagnoses, timing of entry into care, CD4 at diagnosis and rates of progression to AIDS. Tests for trend were used to determine whether statistically significant changes in these indicators were observed over the five-year period. Results indicated that from 2005 to 2009, publically funded testing increased 4.5-fold; the number of newly diagnosed HIV/AIDS cases remained relatively constant. Statistically significant increases in the proportion of cases entering care within three months of diagnosis were observed (p < 0.0001). Median CD4 counts at diagnosis increased over the five-year time period from 346 to 379 cells/µL. The proportion of cases progressing from HIV to AIDS and diagnosed with AIDS initially, decreased significantly (both p < 0.0001). Routine HIV testing and linkage to care efforts in the District of Columbia were temporally associated with earlier diagnoses of cases, more timely entry into HIV-specialized care, and a slowing of HIV disease progression. The continued use of surveillance data to measure the community-level impact of other programmatic initiatives including test and treat strategies will be critical in monitoring the response to the District's HIV epidemic.

Keywords:

• HIV/AIDS
• routine testing
• surveillance
• implementation
• clinical outcomes

Acknowledgments

For their assistance and expertise throughout the study, the authors would like to acknowledge Drs Manya Magnus and Irene Kuo of the George Washington University, and Dr Gregory Pappas, Senior Deputy Director of the DC Department of Health HIV/AIDS, Hepatitis, STD, TB Administration (HAHSTA). This analysis was conducted as a part of the Public Health/Academic Partnership between the District of Columbia Department of Health/HAHSTA and The George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Contract Number POHC-2006-C-0030. Under this contract the District of Columbia Department of Health had the right to review and approve the final version of the manuscript.