1. 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

2. 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

3. 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

4. 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

5. 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%

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

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

8. Seroprevalence of HIV by Perceived Risk
Tester Perception
Seroprevalence # Positive
Zero
Low
0.5%
Moderate
1.8%
High
8.2%
Patient Perception
Seroprevalence # Positive
0.8%
0.8%
1.4%
9.6%

9. 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

10. 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

11. HIV Rapid Testers

12. 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