Missed Opportunities for HIV prevention at an Integrated Hospital System in Bronx, NY
Methods: Retrospective chart review of 82 patients newly diagnosed with HIV in 2012 at varied MMC clinical sites. Data was collected via EMR databases. Missed opportunities were defined as > 1 prior health care encounter within 3 years of diagnosis in which HIV testing was not performed for those who had a prior negative test or no prior test. Descriptive statistics were used to analyze findings.
Results: Of the 82 HIV positive patients, 72% were male, and 80% Black or Latino. 62% of men identified as MSM; 91% of women were heterosexual. Median CD4 count was 326, (29% had CD4 < 200) and the median viral load was 16,490. 67% of patients were diagnosed at outpatient departments (OPDs) or emergency departments (EDs), and 35% had a prior negative HIV test. The most common presenting symptoms included: constitutional symptoms (24%), sexually transmitted infections (STDs) (17%), systemic or opportunistic infections (12%), and follow up after high-risk contact (10%); 21% were asymptomatic.
Among those with prior visits and previous negative HIV tests, 98% of prior visits occurred in EDs or OPDs. 23% of these presented with constitutional symptoms, 23% with STDs, 7% for routine care. The mean number of missed opportunities for testing in this group was 2.4.
Among those with prior visits and no prior HIV tests, 97% of visits occurred in EDs or OPDs. 32% presented with general primary care complaints, 17% with constitutional symptoms, and 14% with acute infections. The mean number of missed opportunities for testing was 3.8.
Conclusion: HIV positive patients continue to present late to care, with variable symptomatology, low CD4, high viral load, and commonly utilize OPDs and EDs, where missed opportunities for early diagnosis are common. Policies that address more systematic, and routine testing across healthcare delivery systems is needed to prevent transmission.
D. Futterman, None