title: Falling through the cracks? Missed opportunities for earlier HIV diagnosis in a New York City Hospital.
abstract: Summary Newly diagnosed HIV-positive patients have frequent health care encounters prior to diagnosis representing missed opportunities for diagnosis. This study determines the proportion of patients with new HIV diagnoses with encounters in the 3 years prior to diagnosis. We describe the characteristics of newly diagnosed patients and of "late testers" (CD4 <200 cells/mm(3) at the time of diagnosis). We identified all newly diagnosed with HIV in emergency department, inpatient, and outpatient settings between May 1, 2006, and December 31, 2009. Data abstractors searched hospital records to identify all emergency department, inpatient, and outpatient visits for the 3 years prior to diagnosis. In all, 23,271 HIV tests were performed and 253 persons were newly diagnosed (1.1%); 152 new positives (60.1%) made at least one prior visit. Of patients with CD4 counts available, 104/175 (59.4%) had CD4 <200 cells/mm(3). Patients with at least one prior visit had a median of three. There was no difference in numbers of visits between late testers and non-late testers, although late testers were more likely to have ED visits. Most newly diagnosed HIV-positive patients had multiple encounters prior to diagnosis. Many of these patients presented with CD4 counts below 200 cells/mm(3), indicating true missed opportunities for earlier diagnosis.
authors.affiliation: Department of Emergency Medicine, St. Luke's Roosevelt Hospital, New York, NY, USA.
authors.forename: Jolene H
authors.initials: JH
authors.lastname: Nakao
authors.affiliation: Department of Emergency Medicine, St. Luke's Roosevelt Hospital, New York, NY, USA.
authors.forename: Dan E
authors.initials: DE
authors.lastname: Wiener
authors.affiliation: David H. Newman, Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Newman
authors.affiliation: Department of Medicine, St. Luke's Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Sharp
authors.affiliation: Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA daniel.egan@nyumc.org.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Egan
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006786:Hospitals, Urban; D006801:Humans; D016015:Logistic Models; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014505:Urban Population; D055815:Young Adult
keywords: HIV testing; HIV/AIDS; Missed opportunities; diagnosis; late presenters; late testers; screening