RETURNING FOR CONFIRMATORY TEST RESULTS: THE CRITICAL LINK BETWEEN “TEST” AND “TREAT” IN RAPID HIV TESTING Matthew B. Feldman, Ph.D., MSW Gay Men’s Health Crisis Elwin Wu, Ph.D. Columbia University School of Social Work
R ETURNING FOR CONFIRMATORY TEST RESULTS : T HE CRITICAL LINK BETWEEN “ TEST ” AND “ TREAT ” IN RAPID HIV TESTING Matthew B. Feldman, Ph.D., MSW Gay Men’s.
Dec 17, 2015
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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
RESULTS:PREDISPOSING FACTORS
Confirmatory TestRefused(n= 39)
Did not return for results(n= 83)
Returned for results(n= 153) p
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
Confirmatory TestRefused(n= 39)
Did not return for results(n= 83)
Returned for results(n= 153) p
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
HousingHomeless/transitional
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
RESULTS:PREDISPOSING FACTORS
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%
RESULTS:PREDISPOSING FACTORS
Marital StatusSingle, never marriedMarried/domestic pt.
Div./sep./widowed
71%23%6%
CitizenshipUS citizen
Not US citizen86%14%
HousingHomeless/transitional
Fam./friend home /apt.Own home/apt.
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
HousingHomeless/transitional
Fam./friend home /apt.Own home/apt.
[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
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