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Missed Opportunities for HIV Prevention: Individuals Who HIV Seroconverted Despite Accessing Healthcare

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Abstract

Individuals with a negative HIV test before a positive one (seroconverters) may represent missed opportunities for prevention. To inform HIV prevention strategies, we aimed to characterize patients who seroconverted despite accessing care. We identified patients at a large, urban healthcare system who seroconverted between 2009 and 2014. Demographics, visits, and HIV-related variables were extracted from the medical records. We performed descriptive statistics, assessed for trends, and tested for associations according to sex. 220 seroconverters were identified: 45% were female, 87% were non-Hispanic Black or Hispanic, and median number of negative tests prior to diagnosis was 2 (IQR 1–3). Overall, 49% reported heterosexual contact as their risk factor and the proportion with heterosexual risk increased over time (24% in 2009 vs. 56% in 2014, p = 0.03). Compared to men, women were older at the time of diagnosis (35 vs. 26 years old, p < 0.01), had more visits between their latest negative and positive HIV test (4 vs. 2, p < 0.01), and were more likely to be diagnosed in the context of screening (64% vs. 56%, p = 0.05). We identified a population that became HIV-infected despite multiple healthcare encounters and undergoing HIV testing multiple times. Patients were mostly heterosexual and almost half were female. To avoid missed opportunities for those already accessing care, HIV prevention efforts should include strategies tailored to individuals with less frequently recognized risk profiles.

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Funding

The Einstein-Rockefeller-CUNY Center for AIDS Research (P30-AI124414) is supported by the following NIH co-funding and participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, and OAR. Additional NIH support was made possible through the following grants: K23MH102129 [OJB], K01HL137557 [DBH], and K23MH102129 [URF].

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Authors and Affiliations

  1. Department of Medicine, Jacobi Medical Center, Bronx, NY, USA

    Francesca Cossarini

  2. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    David B. Hanna & Mindy S. Ginsberg

  3. Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA

    Oni J. Blackstock, Kathryn Anastos & Uriel R. Felsen

Authors
  1. Francesca Cossarini
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  2. David B. Hanna
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  3. Mindy S. Ginsberg
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  4. Oni J. Blackstock
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  5. Kathryn Anastos
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  6. Uriel R. Felsen
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Correspondence to Francesca Cossarini.

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Cossarini, F., Hanna, D.B., Ginsberg, M.S. et al. Missed Opportunities for HIV Prevention: Individuals Who HIV Seroconverted Despite Accessing Healthcare. AIDS Behav 22, 3519–3524 (2018). https://doi.org/10.1007/s10461-018-2162-x

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  • DOI: https://doi.org/10.1007/s10461-018-2162-x

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