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Missed Opportunities: Characteristics of People Who Received a Concurrent HIV/AIDS Diagnosis in New York State From 2016 to 2021....19.0% had a CDX (late diagnosis)
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June 1 2024
Without treatment, HIV progresses to AIDS in approximately 10 years.14 A concurrent diagnosis is defined as an HIV diagnosis that has progressed to stage 3 HIV (AIDS) within 30 days of diagnosis.
Early diagnosis of HIV is 1 of the 3 pillars of the NYS Ending the Epidemic Initiative. Early diagnosis and linkage to care can prevent long-term complications and forward transmission of HIV. The benefits of active antiretroviral therapy can only be realized when people get tested and are aware of their status. It was anticipated that with the advent of active antiretroviral therapy in the mid-1990s, earlier testing would increase. However, this has not been the trend, especially in Europe where stagnant or even increasing rates of late diagnoses are observed.
Despite attempts to encourage earlier diagnosis, the proporton of individuals who receive a CDX has remained relatively stable over the past decade, even as the number of new diagnoses has declined.13 In NYS, the proportion of CDX among new HIV diagnoses trended slightly upward over the six-year period from 17.0% in 2016 to 20.8% in 2021. This could indicate the effectiveness of widespread testing—reaching more people who had not received testing in the past. In addition, this could also indicate that there were many missed opportunities for earlier diagnosis.
Abstract
Background:
Late HIV diagnosis is associated with a wide range of negative outcomes. The aim of this study was to identify the characteristics of individuals who received a concurrent diagnosis (CDX) in New York State (NYS) so that more effective interventions can be developed to encourage earlier testing among these populations.
Methods:
The NYS HIV registry was used to identify people who received a CDX from 2016 to 2021. A CDX was a diagnosis that met the criteria for a stage 3 HIV infection within 30 days of the initial HIV diagnosis. Sex at birth, race/ethnicity, transmission risk group, age at diagnosis, region of residence at diagnosis, urbanicity of zip code of diagnosis, and type of diagnosing facility were used as covariates. Bivariate and multivariate risk ratios were calculated to quantify associations between CDX and covariates.
Results:
There were 14,866 people newly diagnosed with HIV in NYS from 2016 to 2021, of which 19.0% had a CDX. Those with female sex at birth, history of injection drug use, or history of male-to-male sexual contact/history of injection drug use risk were less likely to have a CDX. Increased age, Asian race/ethnicity, residence outside of New York City, and diagnosis at inpatient facilities or emergency rooms were associated with an increased likelihood of a CDX.
Conclusion:
Populations with the highest proportions of CDX were ones that made up a small percentage of all new HIV diagnoses and may not be benefiting as much from current HIV prevention efforts. There are complex interactions between many factors including geographic and social characteristics that may lead to delayed diagnostic testing.
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