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. 2016 Jan 2;30(1):113-20.
doi: 10.1097/QAD.0000000000000896.

Improvements in the continuum of HIV care in an inner-city emergency department

Gabor D Kelen  1 , Yu-Hsiang Hsieh, Richard E Rothman, Eshan U Patel, Oliver B Laeyendecker, Mark A Marzinke, William Clarke, Teresa Parsons, Jordyn L Manucci, Thomas C Quinn
Affiliations

Improvements in the continuum of HIV care in an inner-city emergency department

Gabor D Kelen et al. AIDS. .

Abstract

Objective: The Johns Hopkins Hospital Emergency Department has served as a window on the HIV epidemic for 25 years, and as a pioneer in emergency department-based screening/linkage-to-care (LTC) programs. We document changes in the burden of HIV and HIV care metrics to the evolving HIV epidemic in inner-city Baltimore.

Design/methods: We analyzed seven serosurveys conducted on 18 ,144 adult Johns Hopkins Hospital Emergency Department patients between 1987 and 2013 as well as our HIV-screening/LTC program (2007, 2013) for trends in HIV prevalence, cross-sectional annual incidence estimates, undiagnosed HIV, LTC, antiretrovirals treatment, and viral suppression.

Results: HIV prevalence in 1987 was 5.2%, peaked at more than 11% from 1992 to 2003 and declined to 5.6% in 2013. Seroprevalence was highest for black men (initial 8.0%, peak 20.0%, last 9.9%) and lowest for white women. Among HIV-positive individuals, proportion of undiagnosed infection was 77% in 1987, 28% in 1992, and 12% by 2013 (P < 0.001). Cross-sectional annual HIV incidence estimates declined from 2.28% in 2001 to 0.16% in 2013. Thirty-day LTC improved from 32% (2007) to 72% (2013). In 2013, 80% of HIV-positive individuals had antiretrovirals ARVs detected in sera, markedly increased from 2007 (27%) (P < 0.001). Proportion of HIV-positive individuals with viral suppression (<400 copies/ml) increased from 23% (2001) to 59% (2013) (P < 0.001).

Conclusion: Emergency department-based HIV testing has evolved from describing the local epidemic to a strategic interventional role, serving as a model for early HIV detection and LTC. Our contribution to community-based HIV-screening and LTC program parallels declines in undiagnosed HIV infection and incidence, and increases in antiretroviral use with associated viral suppression in the community.

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Conflict of interest statement

Potential conflicts of interest

We declare no competing interests.

Figures

Figure 1
Figure 1. Trends in HIV Prevalence and Proportion of Undiagnosed Infections (1987–2013)
The black circles denote the HIV prevalence during each identity-unlinked serosurvey. The green squares represent the proportion of HIV positive patients in each identity-unlinked serosurvey who were not aware of their HIV positive serostatus. The vertical lines indicate 95% confidence intervals.
Figure 2
Figure 2. Proportion of HIV Positive Individuals Virally Suppressed and HIV Incidence Estimates (2001–2013)
The green triangles denote the proportion of HIV positive patients with an HIV viral load <400 copies/mL in each identity-unlinked serosurvey. The black circles represent cross-sectional HIV incidence estimates determined by a validated multi-assay algorithm with a window period of 101 days and a 0% false-recent misclassification rate. Vertical lines indicate 95% confidence intervals.
Figure 3
Figure 3
HIV Cascade of Care (2007 and 2013)
See this image and copyright information in PMC

Comment in

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