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Point-of-Care HIV Testing and Linkage in an Urban Cohort in the Southern US

DOI: 10.1155/2013/789413

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Abstract:

The Southern states experience the highest rates of HIV and AIDS in the US, and point-of-care (POC) testing outside of primary care may contribute to status awareness in medically underserved populations in this region. To evaluate POC screening and linkage to care at an urban south site, analyses were performed on a dataset of 3,651 individuals from an integrated rapid-result HIV testing and linkage program to describe this test-seeking cohort and determine trends associated with screening, results, and linkage to care. Four percent of the population had positive results. We observed significant differences by test result for age, race and gender, reported risk behaviors, test location, and motivation for screening. The overall linkage rate was 86%, and we found significant differences for clients who were linked to HIV care versus persons whose linkage could not be confirmed with respect to race and gender, location, and motivation. The linkage rate for POC testing that included a comprehensive intake visit and colocated primary care services for in-state residents was 97%. Additional research on integrated POC screening and linkage methodologies that provide intake services at time of testing is essential for increasing status awareness and improving linkage to HIV care in the US. 1. Introduction Prevention and treatment of Human Immunodeficiency Virus (HIV) infection have evolved through important advances in the field, and the number of new HIV infections in the United States has steadied near 50,000 cases annually [1, 2]. However one-fifth of adults and up to one half of HIV-infected young persons in the United States (US) are not aware of their positive status [3–9]. Considering these statistics, the Centers for Disease Control and Prevention (CDC) released revised recommendations for routine HIV testing during medical visits in US primary care settings [3]; but hurdles to healthcare-based HIV testing still exist at policy, organizational, and individual levels in the Unites States and abroad [10–15]. The recommendations for widespread implementation of standardized opt-out testing in US primary care settings were revised in 2011. Draft revisions in 2013 [16, 17] may address challenges associated with inadequate healthcare, targeted screening, and inaccuracies of individual risk perception [18–20]. As approximately 20% of adults with at least one prior HIV test report a recent (within last 12 months) test in venues outside of primary care offices [14], determining the factors associated with point-of-care (POC) test seeking is an important tactic

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