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A PILOT STUDY TO INCREASE THE EFFICIENCY OF HIV OUTREACH TESTING THROUGH THE USE OF TIMELY AND GEO-LOCATED HIV VIRAL LOAD SURVEILLANCE DATA

Jennings Jacky M; Schumacher, Christina; Perin, Jamie; Myers, Tanya; Fields, Nathan; Greiner Safi, Amelia; Chaulk, Patrick
Sexually Transmitted Diseases: Post Acceptance: October 04, 2017
doi: 10.1097/OLQ.0000000000000730
Original Study: PDF Only

AbstractBackgroundEliminating HIV transmission in a population necessitates identifying population reservoirs of HIV infection and subgroups most likely to transmit. HIV viral load is the single most important predictor of HIV transmission. The objective of this analysis was to evaluate whether a public health practice pilot project based on community viral load resulted in increases in the proportion of time spent testing in high viral load areas (process measure), and three outcome measures - the number and percent of overall HIV diagnoses, new diagnoses and high viral load positives - in one mid-Atlantic U.S. city with a severe HIV epidemic.MethodsThe evaluation was conducted over three, three-month time periods over three years and included the use of community viral load, global positioning system (GPS) tracking data, and statistical testing to evaluate the effectiveness of the pilot project.ResultsThe proportion of time spent outreach testing in high viral load areas (69% to 84%, p<0.001) and the overall number and percent of HIV positives ((60 (3%) to 127 (6%), p<0.001) significantly increased over three years. The number and percent of new diagnoses (3 (0.1%) to 6 (0.2%)) and high viral load positives (5 (0.2%) to 9 (0.4%)) increased but the numbers were too small for statistical testing.DiscussionThese results suggest that using community viral load to increase the efficiency of HIV outreach testing is feasible and may be effective in identifying more HIV positives. The pilot project provides a model for other public health practice demonstration projects.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Background

Eliminating HIV transmission in a population necessitates identifying population reservoirs of HIV infection and subgroups most likely to transmit. HIV viral load is the single most important predictor of HIV transmission. The objective of this analysis was to evaluate whether a public health practice pilot project based on community viral load resulted in increases in the proportion of time spent testing in high viral load areas (process measure), and three outcome measures - the number and percent of overall HIV diagnoses, new diagnoses and high viral load positives - in one mid-Atlantic U.S. city with a severe HIV epidemic.

Methods

The evaluation was conducted over three, three-month time periods over three years and included the use of community viral load, global positioning system (GPS) tracking data, and statistical testing to evaluate the effectiveness of the pilot project.

Results

The proportion of time spent outreach testing in high viral load areas (69% to 84%, p<0.001) and the overall number and percent of HIV positives ((60 (3%) to 127 (6%), p<0.001) significantly increased over three years. The number and percent of new diagnoses (3 (0.1%) to 6 (0.2%)) and high viral load positives (5 (0.2%) to 9 (0.4%)) increased but the numbers were too small for statistical testing.

Discussion

These results suggest that using community viral load to increase the efficiency of HIV outreach testing is feasible and may be effective in identifying more HIV positives. The pilot project provides a model for other public health practice demonstration projects.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Address correspondence to: Jacky M. Jennings, Ph.D., M.P.H., Associate Professor, Dept of Pediatrics, School of Medicine, The Johns Hopkins University Bayview Medical Center, 5200 Eastern Avenue, Mason F. Lord Bldg - Center Towers, Ste 4200, Baltimore, MD 21224, T 410-550-4132 F 410-550-4153. jjennin1@jhmi.edu

Conflicts of Interest and Sources of Support: This study was supported by the Centers for Disease Control and Prevention Category C Innovative Demonstration Program (PS12-1201). The authors report no conflicts of interest.

Short Summary

A pilot project in Baltimore City, Maryland suggests that using community viral load to increase the efficiency of HIV outreach testing is feasible and may be effective in identifying more HIV positives.

Received for publication May 8, 2017, and accepted September 9, 2017.

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