R ETURNING FOR CONFIRMATORY TEST RESULTS : T HE CRITICAL LINK BETWEEN “ TEST ” AND “ TREAT ”...

RETURNING FOR CONFIRMATORY TEST RESULTS: THE CRITICAL LINK

BETWEEN “TEST” AND “TREAT” IN RAPID HIV TESTING

Matthew B. Feldman, Ph.D., MSWGay Men’s Health Crisis

Elwin Wu, Ph.D.Columbia University School of Social Work

THE “TEST” AND “TREAT” INITIATIVE

• Increase the number of people who become aware that they are HIV-positive through expanded testing efforts

• Link recently HIV-infected individuals to medical care

• Initiate HAART at earlier stages of disease

(Dieffenbach & Fauci, 2009; Dodd, Garnett, & Hallett, 2010)

IDENTIFYING HIV-POSITIVE INDIVIDUALS USING RAPID HIV

TESTING• Reactive rapid test results must be confirmed by a

Western Blot

• Confirmatory HIV test results are usually available within 1-2 weeks

• Most HIV social service and medical organizations require documentation of a positive confirmatory HIV test result before services can be initiated

FAILURE TO RETURN RATES FOR HIV TEST RESULTS

• Failure to return rates for confirmatory HIV test results range from 19-25%

(Antonio-Gaddy et al., 2006; Bowles et al., 2008; Bucher et al., 2007)

• Failure to return rates for conventional HIV test results range from 11%-58%

(Desai & Rosenheck, 2004; Erbelding et al., 2004; Hightow et al., 1999; Lazebnik et al., 2001 Molitor et al., 1999; Stein & Nyamathi, 2000; Slutsker et al., 1992; Tao et al., 1999; Valdisseri et al., 1993; Wiley et al., 1998; Zick et al., 2000)

PREDICTORS OF FAILING TO RETURN FOR HIV TEST

RESULTS

(Desai & Rosenheck, 2004; Ellen et al., 2004; Erbelding et al., 2004; Hightow et al., 1999; Kinsler et al., 2007; Lazebnik et al., 2001 Molitor et al., 1999; Reynolds et al., 2005; Stein & Nyamathi, 2000; Slutsker et al., 1992; Tao et al., 1999; Valdisseri et al., 1993; Wiley et al., 1998; Zick et al., 2000)

•Age•Gender•Race•Education•Substance use•Sexual risk behavior

•Sexual exchange•Visit reason•HIV testing history•STD symptoms/diagnosis•HIV testing site

THE MISSING LINK BETWEEN “TEST” AND “TREAT” IN RAPID

HIV TESTING

Rapid Test

Receive Negative Result

Receive Preliminary

Positive Result

Refuse Confirmatory

Test

Do not receive

Confirmatory Result

Receive Positive

Confirmatory Result

Treatment?

STUDY AIMS

• To describe the prevalence of returning for confirmatory HIV test results among individuals newly diagnosed HIV-positive at GMHC’s HIV testing and counseling center

• To examine the sociodemographic and psychosocial correlates of returning for confirmatory HIV test results

UNDERSTANDING RETURNING FOR CONFIRMATORY HIV TEST RESULTS: THE BEHAVIORAL MODEL OF HEALTH

SERVICES USE (ANDERSEN ET AL., 2000)

GMHC HIV TESTING PROCEDURES

• Confidential, code-based rapid HIV testing is conducted on-site, off-site, and in a mobile testing unit by trained HIV testing counselors/phlebotomists

• Pre- and post-test counseling is provided to all individuals who receives an HIV test

• Individuals with a preliminary positive result are asked to return in 1-2 weeks for confirmatory HIV test results

SAMPLETested for HIV

(n= 9234)

HIV-negative(n= 8853, 95.9%)

HIV-positive(n= 372, 4%)

Known Positives

(n= 97, 26%)

Newly diagnosed HIV-positive

(n= 275, 74%)

Indeterminate(n= 4, 0.0%)

Refused Confirmatory HIV testing (n= 39, 14%)

Did not return for HIV confirmatory test results

(n= 83, 30%)

False Positive(n= 5, 0.1%)

Returned for HIV confirmatory test results

(n= 153, 56%)

RESULTS:PREDISPOSING FACTORS

Confirmatory TestRefused(n= 39)

Did not return for results(n= 83)

Returned for results(n= 153) p

Age, yrs. M (SD) 36.2 (10.9) 35.7 (11.0) 33.3 (10.0) .23

SexFemale

Male8%

92%11%89%

3%97%

.03

RaceBlack

LatinoWhiteOther

38%33%26%3%

27%42%24%7%

31%33%29%7%

.64

Sexual orientationHeterosexual

Non-heterosexual15%85%

20%80%

3%97%

< .001

Education> HS/GED

HS/GED< HS/GED

54%23%23%

57%20%23%

72%16%11%

.06





Marital StatusSingle, never marriedMarried/domestic pt.

Div./sep./widowed

74%21%5%

70%24%6%

71%23%6%

.99

CitizenshipUS citizen

Not US citizen92%8%

92%8%

81%19%

.05

HousingHomeless/transitional

Fam./friend home /apt.Own home/apt.

10%10%80%

5%11%84%

10%19%71%

.16

RESULTS:ENABLING AND NEED FACTORS




Health InsuranceInsured

Uninsured83%17%

74%26%

54%46%

.002

Test locationOff-siteOn-site

36%64%

28%72%

5%95%

<.001

HIV testing historyPreviously tested

Not previously testedUnknown

67%28%6%

68%25%7%

78%16%6%

.28

Months since last testM (SD) 32 (53) 32 (49) 23 (30) .27

RESULTS

Refused Confirmatory TestDid not return for

confirmatory results

OR (95% CI) p OR (95% CI) p

Female 1.4 (0.1,14.0) .80 1.3 (0.2,8.7) .78

Heterosexual 1.9 (0.3, 12.4) .51 4.9 (1.0, 22.9) .05

Education> HS/GED

HS/GED< HS/GED

[reference]1.7 (0.5, 5.7)1.4 (0.4, 5.7)

.43

.61

[reference]1.8 (0.7, 4.3)1.4 (0.5, 4.3)

.25

.54

US Citizen 7.1 (0.8, 58.2) .06 2.2 (0.8, 6.4) .13

Has health insurance 3.7 (1.2, 11.1) .02 1.8 (0.8, 3.9) .13


Fam./friend home /apt.

Own home/apt.

[reference]2.3 (0.3, 16.8)3.1 (0.6, 15.7)

.41

.17

[reference]4.1 (0.7, 23.4)5.8 (1.2, 28.1)

.11

.03

Off-site test location 5.4 (1.7, 16.9) .003 3.3 (1.2, 9.4) .03

• A substantial proportion of individuals (45%) in this sample would not have progressed through the early phase of test and treat

• Health insurance, HIV test site, sexual orientation, and housing situation emerged as significant predictors of returning for confirmatory HIV test results

CONCLUSION

• First study to examine the correlates of returning for confirmatory test results

• Limitations

DISCUSSION

• Need to better understand the reasons people fail to return for confirmatory test results, particularly in the context of off-site HIV testing

• Challenge: how can post-test counseling address psychosocial obstacles to returning for confirmatory test results?

IMPLICATIONS AND NEXT STEPS

ACKNOWLEDGMENTS

• Lynnette Ford• Stephen Hile• Blakeley Lowry• Moira Mendoza• Jeff Rindler

[email protected]


Age, yrs. M (SD) 34.7 (10.5)

SexFemale

Male6%

94%

RaceBlack

LatinoWhiteOther

31%36%27%6%

Sexual orientationHeterosexual

Non-heterosexual10%90%

Education> HS/GED

HS/GED<HS/GED

65%19%16%


Marital StatusSingle, never marriedMarried/domestic pt.

Div./sep./widowed

71%23%6%

CitizenshipUS citizen

Not US citizen86%14%



9%15%76%

RESULTS:ENABLING AND NEED FACTORS

Health InsuranceInsured

Uninsured65%35%

Test locationOff-siteOn-site

16%84%

HIV testing historyPreviously tested

Not previously testedUnknown

73%20%7%

Months since last testM (SD) 27 (39)

ResultsReturned for confirmatory results

OR (95% CI) p

Female 0.8 (0.,4.6) .75

Heterosexual 0.3 (0.1, 1.2) .09

Education> HS/GED

HS/GED<HS/GED

[reference]0.6 (0.2, 1.4)0.7 (0.3, 2.0)

.27

.56

US Citizen 0.3 (0.1, 0.9) .03

Has health insurance 0.4 (0.2, 0.9) .02



[reference]0.3 (0.1, 1.3)0.2 (0.1, 0.8)

.11

.03

Off-site test location 0.2 (0.1, 0.6 .003

R ETURNING FOR CONFIRMATORY TEST RESULTS : T HE CRITICAL LINK BETWEEN “ TEST ” AND “ TREAT ”...

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