Earlier diagnoses and faster treatment of HIV in the District of Columbia: HIV surveillance analysis, 2006–2016

ABSTRACT

To address high HIV prevalence, the District of Columbia (DC) Department of Health has implemented multiple strategies to increase routine HIV testing since 2006. Examination of delayed HIV diagnosis over time can demonstrate population-level impact of public health strategies to promote HIV testing. Using HIV surveillance data, we examined delayed HIV diagnosis in DC (stage 3 within 90 days of diagnosis), CD4 count at HIV diagnosis, linkage to HIV care, and time to viral suppression among DC residents age 13 and above who were diagnosed from 2006 to 2016.  We used the Cochran-Armitage test of trend, Cuzick’s test of trend, and Chi-square for univariate analyses, and we examined factors associated with delayed HIV diagnosis using a log-binomial multivariate model. 7,937 DC residents were diagnosed with HIV and had available data.  Between 2006 and 2016, delayed HIV diagnoses declined from 36.4% to 25.5%, median CD4 count increased from 190 cells/µl to 426 cells/µl, and median time from HIV diagnosis to viral suppression declined from 1,136 days to 84 days.  Women, youth ages 13-29, and men who have sex with men had lower proportions with delayed HIV diagnosis. In the multivariate models, racial/ethnic disparities in delayed HIV diagnoses were apparent during 2006-2008 but not during 2009-2016. Continued efforts around earlier HIV testing are needed in DC.

KEYWORDS:

• Delayed HIV diagnosis
• linkage to care
• viral suppression
• disparities

Acknowledgements

Thank you to Suparna Das, Kate Drezner, and Jenevieve Opoku of DC Department of Health for reviewing early versions of this manuscript. We would like to acknowledge the residents of DC whose data were used in this analysis. We also acknowledge the many staff members of DC Department of Health who have supported the HIV surveillance system and administered programs, as well as community-based organizations and clinical providers who have reported HIV surveillance data and have conducted HIV testing, prevention, care, treatment, support services and capacity building services in DC.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Rupali K. Doshi http://orcid.org/0000-0002-4799-7907

Kerri Dorsey http://orcid.org/0000-0002-3192-2193

Additional information

Funding

This work was supported by DC Department of Health (District of Columbia Department of Health) under contract CW29654 with George Washington University. DC Department of Health receives funding from the CDC under CDC-RFA-PS18-1802 to conduct routine HIV surveillance and prevention activities; however, federal funds were not used to conduct this analysis.