Philadelphia Department of Public Health Can HIV Testing be Based on Risk Estimation? A Population-Based Survey with HIV Testing Helena Kwakwa, MD, MPH; Catherine Holdsworth, CRNP, Patrick Doggett, MA; Linda Robb, MSW & Rita Ebuoroh, MD Philadelphia Department of Public Health

HIV Testing in Philadelphia’s District Health Centers 8 District Health Centers in Philadelphia’s neighborhoods Approximately 100,000 individuals served annually Universal HIV testing conducted in Family Planning and Prenatal Care Clinics Universal conventional testing conducted in Family Medical Clinics Universal rapid testing in Walk-in Clinics initiated July 2007

HIV Rapid Testing in Urgent Care Clinics at Philadelphia’s District Health Centers Counseling and written informed consent required by Pennsylvania state law Patients seeking care in walk-in clinics offered rapid HIV testing by triage nurse Testing and counseling performed by dedicated Rapid Testers Demographic, risk behavior, testing history and perception of risk data collected

Population Tested and Population HIV-Positive by Race/Ethnicity 100% 100% 86% 73% 50% 50% 13% 10% 6% 4% 4% 4% African Hispanic Caucasian Foreign American Born African Hispanic Caucasian Foreign American Born

Population Tested Compared with Population HIV-Positive – Gender, Testing History and Risk Behaviors Female 57% 44% Mean / Median age 35 / 32 38 / 39 Ever tested for HIV 67% 68% Received results 80% 78% Same sex behavior / identification 7% / 3% 38% / 14% Consistent condom use 10.5% 10% Cocaine/heroin use ever 23% / 2% 49% / 5%

Tester and Patient Perception of Risk: Population Tested Tester Perception of Risk Patient Perception of Risk 6% 3% 10% 8% 13% 42% 47% 70%

Tester and Patient Perceptions of Risk: Population HIV-Positive Tester Perception of Risk Patient Perception of Risk 36% 32% 46% 30% 10% 22% 24%

Seroprevalence of HIV by Perceived Risk Tester Perception Seroprevalence # Positive Zero 0 0 Low 0.5% 16 Moderate 1.8% 11 High 8.2% 23 Patient Perception Seroprevalence # Positive 0.8% 15 0.8% 18 1.4% 5 9.6% 12

Low Perceived Risk for HIV and HIV-Positive: Who Are They? 16 patients 14 African American, 1 Caucasian, 1 Haitian 10 men, 6 women 10 tested in past 9 received results 14 reported one sexual partner in previous year, 2 reported none None reported same-sex encounters All used condoms sometimes or never None had ever exchanged sex for drugs or money 5 had used cocaine in distant past, 1 heroin All 6 reported negative test following last drug use

Conclusions Seroprevalence of HIV in this cohort grew as perceived risk increased Although seroprevalence in the group with low perceived risk was 0.5%, 16 of the 50 HIV-positive individuals were in this group Zero risk as perceived by patients was inaccurate, but as perceived by testers was accurate Universal testing, even among those with low HIV risk, is an important component of the effort to identify the HIV-positive who are unaware of their status

HIV Rapid Testers

Acknowledgements Kalpana Vaidya, MD Thomas Storey, MD, MPH James Dean, MD Nino Vittorio, MD Mira Gohel, MD Cynthia Venegas, MD Anitha Vuppalapathi Cyrilene Eastmond, MD Cheryl Bettigole, MD, MPH Kristi Johnson, MD Millen Gebreselassie, MD Shainy Thaiparambil, RN Joan Bland, RN Patricia Zelenak, RN Adele Holloway, RN Darnell Wilkerson Patricia Nesmith, RN Stuart Katz Pamela Graves, RN Gloria Alford Gerry Keys PA/MA AIDS ETC