502. The potential impact of PrEP implementation at CDC-funded nonclinical HIV testing venues
Session: Poster Abstract Session: HIV Prep and PEP
Thursday, October 27, 2016
Room: Poster Hall
  • IDWeek2016-KungWestergaard.pdf (1.3 MB)
  • Background:

    Targeted HIV testing programs in nonclinical settings are supported by CDC to deliver testing services to individuals who are at high-risk for HIV but are not engaged in routine medical care. These programs may similarly be effective but under-utilized venues for implementing pre-exposure prophylaxis (PrEP). To provide insight into the potential impact of scaling-up PrEP implementation at CDC-funded, nonclinical HIV testing sites, we evaluated the proportion of new HIV diagnoses in the U.S. resulting from tests conducted at these sites.


    We analyzed publicly-available data from the CDC Annual HIV Testing Report and HIV Surveillance Report from 2014 to determine the proportion of new HIV diagnoses in each U.S. state resulting from testing events in nonclinical settings. To assess the potential number of HIV cases that might prevented under ideal conditions when PrEP is universally delivered to high-risk clients who test negative, we then analyzed client-level data collected from the Wisconsin Division of Public Health’s Confidential HIV Testing and Referral (CTR) Program. Using a unique identification code entered by clients at the time of testing, we identified cases of confirmed new HIV diagnosis that could be linked to a prior, negative HIV testing event at a CTR site.


    Of 39,566 new diagnoses of HIV reported to CDC from 49 states during 2014, 5,136 were made at CDC-funded nonclinical settings (13% overall, range 0% to 28%). In Wisconsin, 52 of 218 (24%) diagnoses occurred in such settings. Using Wisconsin HIV surveillance data, we found that among 790 new HIV diagnoses made between 2008 and 2015, 119 provided a client ID that matched an earlier negative test, representing a client who was engaged in CTR services both before and after HIV transmission occurred.


    A substantial number of HIV infections may be preventable if there was a robust mechanism for linking CTR clients to highly effective prevention services. Our findings are subject to numerous limitations, including analysis of data aggregated from published reports, which may not reflect site-specific variations in data collection or reporting. Implementation and evaluation of PrEP programs in non-clinical settings appears warranted.

    Vanessa Kung, PhD1, Danielle Kahn, MPH1, Jacob Dougherty, BA2, Megan Elderbrook, MPH2, Casey Schumann, MS2, Mari Gasiorowicz, MA2, James Vergeront, MD2, Timothy Hess, PhD1 and Ryan Westergaard, MD, PhD, MPH1, (1)Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, (2)Wisconsin AIDS/HIV Program, Wisconsin Department of Health Services, Madison, WI


    V. Kung, None

    D. Kahn, None

    J. Dougherty, None

    M. Elderbrook, None

    C. Schumann, None

    M. Gasiorowicz, None

    J. Vergeront, None

    T. Hess, None

    R. Westergaard, None

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