Background STD Clinics are one venue in which to identify HIV-diagnosed persons disengaged from HIV care.
Methods We analysed data from previously HIV-diagnosed patients seen in the STD Clinic in Seattle, Washington, USA, October 2010-December 2012. The clinic uses a computer-assisted self-interview (CASI) during new problem visits, which queries HIV-diagnosed patients about their HIV care history. Clinicians interview patients who do not complete the CASI. We used chi-squared tests to compare the reasons for STD Clinic visits and HIV transmission risk factors in visits at which patients were non-engaged (self-reported out of care or > 6 month gap in care) compared to engaged in HIV care.
Results Of 1369 visits among previously diagnosed HIV-infected persons, 913 (67%) included CASI. CASI visit patients were younger (median age 40 vs. 44 years, p < 0.001) and more often MSM (96% vs. 88%, p < 0.001) than non-CASI visit patients. Of the 1233 (90%) visits with HIV care data, 20% were non-engaged. More CASI than non-CASI visits were ascertained as non-engaged (22% vs. 11%; p < 0.001). Symptoms were the visit reason more frequently at non-engaged than engaged visits (47% vs. 40%; p = 0.001), and non-engaged visits were more likely to result in a diagnosis of gonorrhoea (27% vs. 17%, p < 0.001) or syphilis (13% vs. 9%, p = 0.04). Although patients reported unprotected anal intercourse with HIV-negative or unknown status partners (nonconcordant UAI) in the past year in 36% of both non-engaged and engaged visits, self-report of a detectable serum HIV RNA level plus nonconcordant UAI was more frequent in non-engaged than engaged visits (23% vs. 11%; p < 0.001).
Conclusions Many persons who are disengaged from HIV care seek evaluation in STD clinics. These patients are at elevated risk for transmitting HIV. Computer-based efforts to assess HIV care engagement increase identification of out-of-care persons, an important first step for re-linkage to HIV care.
- Computer-Assisted Self Interview
- HIV Care Engagement
- STD Clinic
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