376. Rutgers New Jersey Medical School HIV Screening Compliance Are We Missing Opportunities?
Session: Poster Abstract Session: HIV Epidemiology: Screening and Testing - Outpatient to Inpatient
Thursday, October 8, 2015
Room: Poster Hall
Background:

Newark, NJ has been disproportionately affected by the HIV epidemic, with a prevalence rate 8 times greater than the remainder of NJ and among the highest rates (3.3%) in the US.  University Hospital (UH) Emergency Department (ED) and Medical Clinics are located in Newark and have access to an onsite rapid HIV testing program which connects newly diagnosed persons to care.

Methods:

We conducted a retrospective chart review of new patients seen at the Infectious Diseases Practice (IDP) from 1/1/13 to 12/31/14. We included adults newly diagnosed with HIV (no history of HIV or if visit mentioned “newly diagnosed”).  Charts were reviewed to see if the patient visited a healthcare provider at University Hospital in the year prior to their first clinic visit and included the date and location of visit, and whether the patient was screened for HIV at that time.  

Results:

We reviewed 314 patients and included 117 (35%) newly diagnosed patients in our analysis.  The mean age of the patients was 36.8, 71% were Black and 21% Hispanic or other, 62% were men and the most common risk factor was MSM (28%).  35 (30%) had at least one missed opportunity (MO) for screening.   The total number of MOs was 126 with a mean of 3.6 MOs per patient.  The mean viral load at diagnosis was 38% higher for patients with a MO than those without a MO.  23 (28%) with no MO had initial CD4 counts < 200 while 11 (31%) of patients with a MO had an initial CD4 count <200.  However, 29% of newly diagnosed had AIDS and 17% had CD4 counts of < 50 cells/cu mm at presentation.  The two most common locations of a MO were the Emergency Department (45%) and medical clinics (37%).

Conclusion:

Almost 1/3rd of patients newly diagnosed with HIV had an opportunity to be screened and diagnosed earlier in their disease.  Despite the availability of onsite HIV screening and connection to care, 30% of newly diagnosed patients had at least 1 MO and 31% of those had AIDS at presentation.  This suggests that these patients had likely been infected with HIV for more than 1 year. Therefore, our data clearly demonstrates the need for greater awareness and improved universal screening for HIV in all healthcare settings with high background HIV prevalence to allow for earlier diagnosis and treatment, and ultimately improved HIV-related health outcomes.

Joseph Derose, DO, Internal Medicine Residency Program, Rutgers New Jersey Medical School, Newark, NJ, Jason Zucker, MD, Medicine and Pediatrics, Rutgers New Jersey Medical School, Newark, NJ, David Cennimo, MD, Internal Medicine and Pediatrics, Rutgers New Jersey Medical School, Newark, NJ and Shobha Swaminathan, MD, Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ

Disclosures:

J. Derose, None

J. Zucker, None

D. Cennimo, None

S. Swaminathan, None

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