207867 Self-reported HIV testing delay in North Carolina

Monday, November 9, 2009

Sonia Napravnik, PhD , Departments of Medicine and Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Evelyn Byrd Quinlivan, MD , Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Emily S. Brouwer, MPH PharmD , Departments of Medicine and Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Peter A. Leone, MD , Departments of Medicine and Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Evelyn M. Foust, CPM MPH , NC Department of Health and Human Services, North Carolina Division of Public Health, Raleigh, NC
Myron Cohen, MD , Departments of Medicine and Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Heidi Swygard, MD MPH , Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Arlene C. Sena, MD, MPH , Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Cynthia Gay, MD MPH , Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Lisa B. Hightow-Weidman, MD, MPH , Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Kristine B. Patterson, MD , Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Joseph J. Eron, MD , Division of Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Background: Linking HIV-infected individuals to care early after infection is critical for individual clinical outcomes and interrupting transmission. Therefore, we assessed self-reported HIV testing delay in North Carolina.

Methods: Interviews were conducted in a sample of HIV clinical cohort study participants. Patients reported the year they believed they acquired HIV and the time between assumed infection and testing (self-reported HIV testing delay). In multivariable log-linear models, we assessed predictors of HIV testing delay including: sociodemographic characteristics (age, sex, race, rural residence, insurance, income, education), behavioral factors (alcohol and drug use), and mode of HIV transmission.

Results: The 333 patients were 36% women, 72% African American, and median age of 34 years (IQR: 28, 40). Sixty-four percent of patients reported a year they believed they acquired HIV (median year=1991, IQR: 1988, 1995). Patients acquiring HIV through MSM transmission and diagnosed pre-1997 were more likely to report an estimated year of infection (RR=1.8, 95% CI: 1.1, 3.0; RR=2.7, 95% CI: 1.7, 4.3). The median self-reported HIV testing delay was 1 year (IQR: 0, 4), and was associated with age (1.5 year longer delay for each 10 year increase in age, P<0.001) and calendar year of infection (4 month shorter delay with increasing calendar year, P<0.001).

Conclusions: Some of our patients suspected they had acquired HIV yet delayed seeking an HIV test, with over a quarter reporting a testing delay of over 4 years. Systems of care that reduce time from infection to care initiation need to be a priority.

Learning Objectives:
Assess predictors of self-reported testing delay among HIV-infected patients in North Carolina. Evaluate the differences in self-reported HIV infection date among patients in North Carolina.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am trained in epidemiology and pharmacy with a focus in HIV treatment. Currently I am working towards my doctoral degree in epidemiology which will focus on long-term outcomes of individuals infected with HIV.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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