146. Geographic Information Systems-based Screening and Linkage to Care for TB, HIV, and Syphilis
Session: Oral Abstract Session: HIV Primary Care and Antiretroviral Therapy, Epidemiology and Testing
Friday, October 21, 2011: 9:15 AM
Room: 157ABC
Background: 

Tuberculosis (TB), syphilis, and human immunodeficiency virus (HIV) disproportionately afflict persons with suboptimal healthcare access; clinic-based screening may therefore miss the highest-risk persons.  Community-based screening using geographic information systems (GIS) with targeted follow-up may be a more efficient strategy.

Methods: 

The residences of TB, HIV, and syphilis cases incident between 1/1/05-12/31/07 and residing in Wake County, North Carolina were mapped using ArcMap 9.3 GIS software. Areas with high densities of all 3 diseases were designated “hot spots.”  Screening fairs were conducted at the hot spots, with small incentives used to attract participants.  Combined screening for TB, HIV, and syphilis with a single blood draw was used.  Participants with positive tests for HIV, syphilis, and/or TB were referred to the health department for further evaluation and treatment.

Results: 

The 252 participants came from high-risk populations: 67% were previously incarcerated, 40% had lived in a homeless shelter, and 29% had a history of crack cocaine use.  However, 58% reported no prior HIV testing, and 41% reported no prior tuberculin skin testing.  A total of 3% of participants had HIV infection and 15% had latent TB infection, compared to 0.4% and 5.6% general population prevalence of these conditions, respectively.  Forty-eight (19%) participants had serologic evidence of syphilis infection.  Of the eight persons with HIV, one was newly diagnosed and co-infected with latent TB; he was linked to an HIV provider, still under care at six-month follow up. Two other HIV-positive persons had fallen out of care, and as a result of the study were linked back into HIV clinics.  Of 31 persons with latent TB who were offered therapy, seven initiated rifampin and three completed treatment.  Of 48 persons with serologic evidence of syphilis infection, three were newly diagnosed and are being pursued for treatment. 

Conclusion: 

GIS-based screening can effectively penetrate a population with high disease burden and poor healthcare access.  Linkage to care remains challenging and will require creative interventions to impact incidence and mortality from these infections.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Neela Goswami, MD1, Emily Hecker, RN, MSN1, Carter Vickery, BA, MBA2, Carla Piedrahita, BS2, Marshall Ahearn, BS1, Gary Cox, MD1, David Holland, MD1, Susanna Naggie, MD1, Yvonne Torres, MS2, Debbie Turner, RN2 and Jason Stout, MD, MHS1, (1)Duke University Medical Center, Durham, NC, (2)Wake County Human Services, Raleigh, NC

Disclosures:

N. Goswami, None

E. Hecker, None

C. Vickery, None

C. Piedrahita, None

M. Ahearn, None

G. Cox, None

D. Holland, None

S. Naggie, None

Y. Torres, None

D. Turner, None

J. Stout, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.