Falling through the cracks? Missed opportunities for earlier HIV diagnosis in a New York City Hospital

Jolene H. Nakao, Dan E. Wiener, David H. Newman, Victoria L. Sharp, Daniel J. Egan

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Newly diagnosed HIV-positive patients have frequent health care encounters prior to diagnosis representing missed opportunities for diagnosis. This study determines the proportion of patients with new HIV diagnoses with encounters in the 3 years prior to diagnosis. We describe the characteristics of newly diagnosed patients and of “late testers” (CD4 <200 cells/mm3 at the time of diagnosis). We identified all newly diagnosed with HIV in emergency department, inpatient, and outpatient settings between May 1, 2006, and December 31, 2009. Data abstractors searched hospital records to identify all emergency department, inpatient, and outpatient visits for the 3 years prior to diagnosis. In all, 23,271 HIV tests were performed and 253 persons were newly diagnosed (1.1%); 152 new positives (60.1%) made at least one prior visit. Of patients with CD4 counts available, 104/175 (59.4%) had CD4 <200 cells/mm3. Patients with at least one prior visit had a median of three. There was no difference in numbers of visits between late testers and non-late testers, although late testers were more likely to have ED visits. Most newly diagnosed HIV-positive patients had multiple encounters prior to diagnosis. Many of these patients presented with CD4 counts below 200 cells/mm3, indicating true missed opportunities for earlier diagnosis.

Original languageEnglish
Pages (from-to)887-893
Number of pages7
JournalInternational Journal of STD and AIDS
Volume25
Issue number12
DOIs
StatePublished - 13 Oct 2014
Externally publishedYes

Keywords

  • Diagnosis
  • HIV testing
  • HIV/AIDS
  • Late presenters
  • Late testers
  • Missed opportunities
  • Screening

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