What predicts HIV late testing in Minnesota?

Background: Despite scaling up HIV/AIDS interventions, one in three are diagnosed with HIV/AIDS at an advanced stage of disease. These so-called HIV late testers often have worse health outcomes and represent a missed opportunity to prevent onward HIV transmission. Few studies have investigated HIV late testing in low-to-medium HIV prevalence regions in the United States.

Objectives:

• To describe trends of HIV late testing in Minnesota
• To compare two definitions of HIV late testing
• To identify factors associated with HIV late testing

Methods: Demographic and clinical data on new HIV/AIDS diagnoses between 2002 and 2011 in Minnesota were obtained from the state’s enhanced HIV/AIDS Reporting System (eHARS) database. The proportion of late testers was calculated using a time-based (developing AIDS within 12 months of diagnosis) or laboratory-based (having a baseline CD4 count ≤ 350 cells/μL) definition. Predictors of HIV late testing were assessed through multivariate logistic regression.

Preliminary results: Between 2002 and 2011, 3,153 individuals were newly diagnosed with HIV/AIDS in Minnesota, of whom 32.6% (time-based criteria) and 51.6% (laboratory-based criteria) were late testers. The rate of HIV late testing using either measure was stable over time. People over 45 years old, Hispanics, African-born immigrants, and those without an indicated risk were more likely to be late testers than other groups. 

Conclusion: Despite efforts to diagnose HIV/AIDS in a timely manner, the proportion of late testers remains high. The demographic characteristics of HIV late testers in Minnesota are different from the risk groups traditionally targeted by HIV testing programs.