MOPDC0306 - Poster Discussion
Using surveillance data to identify HIV-positive persons out-of-care (OOC) in New York City (NYC) and offer linkage to care and HIV partner services
Presented by Chi-Chi Udeagu (United States).
C.-C. Udeagu, T. Webster-León, A. Bocour, P. Michel, C. Shepard
New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, Queens, United States
Background: Persons living with HIV (PLWH) require regular medical care to achieve a consistently suppressed viral load (VL) and its associated benefits of reduced morbidity, mortality, and probability of sexual transmission to HIV-uninfected partners. Only 51% of PLWH in the US, however, are retained in care. In 2008, the NYC health department began using its HIV Surveillance Registry (HSR) to identify OOC PLWH, re-engage them in care, and offer partner services.
Methods: A CD4 or VL report in HSR was considered a proxy for receipt of care. PLWH were considered OOC and prioritized for outreach if lacking care during the previous 9 months and had a NYC residential address at last report in HSR. Located OOC persons were offered partner and linkage-to-care services. Reasons for OOC were ascertained, and partners were notified and tested for HIV. Return-to-care was confirmed using HSR.
Results: From 7/2008 to 12/2010, 797 PLWH were prioritized for outreach; 14% were never located. Of 689 who were traced, 229 (33%) were actually current to care in NYC, 30 (5%) had moved or were incarcerated, 16 (2%) had died, and 414 were verified OOC. Most verified OOC were black or Hispanic (97%), US-born (73%), male (55%), or 40-49 years old (42%). Once located, 327/414 (79%) expressed willingness to return to care and received clinic appointments; 237/327 (72%) were confirmed as having returned to care. Among the 161 who provided reasons for being OOC, the most commonly reported was “felt well” (41%). Only 52/414 (16%) OOC PLWH named partners; 40 (62%) of 65 named partners were traced, and 3 (13%) of 22 partners with unknown or negative HIV serostatus were newly-diagnosed with HIV.
Conclusions: Health department-based outreach initiatives utilizing surveillance registries can successfully re-engage OOC PLWH in medical care, but partner notification among OOC may yield few new HIV diagnoses.
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