title: Feasibility of Using HIV Care-Continuum Outcomes to Identify Geographic Areas for Targeted HIV Testing.
abstract: BACKGROUND
  Improved detection and linkage to care of previously undiagnosed HIV infections require innovative approaches to testing. We sought to determine the feasibility of targeted HIV testing in geographic areas, defined by continuum of care parameters, to identify HIV-infected persons needing linkage or engagement in care.
  
  
  METHODS
  Using HIV surveillance data from Washington, DC, we identified census tracts that had an HIV prevalence >1% and were either above (higher risk areas-HRAs) or below (lower risk areas-LRAs) the median for 3 indicators: monitored viral load, proportion of persons out of care (OOC), and never in care. Community-based HIV rapid testing and participant surveys were conducted in the 20 census tracts meeting the criteria. Areas were mapped using ArcGIS, and descriptive and univariate analyses were conducted comparing the areas and participants.
  
  
  RESULTS
  Among 1471 persons tested, 28 (1.9%) tested HIV positive; 2.1% in HRAs vs. 1.7% in LRAs (P = 0.57). Higher proportions of men (63.7% vs. 56.7%, P = 0.007) and fewer blacks (91.0% vs. 94.6%, P = 0.008) were tested in LRAs vs. HRAs; no differences were observed in risk behaviors between the areas. Among HIV-positive participants, 54% were new diagnoses (n = 9) or OOC (n = 6), all were Black, 64% were men with a median age of 51 years.
  
  
  CONCLUSIONS
  Although significant differences in HIV seropositivity were not observed between testing areas, our approach proved feasible and enabled identification of new diagnoses and OOC HIV-infected persons. This testing paradigm could be adapted in other locales to identify areas for targeted HIV testing and other reengagement efforts.
authors.affiliation: *Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC; †Community Education Group, Washington, DC; and ‡District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, TB Administration, Washington, DC.
authors.forename: Amanda D
authors.initials: AD
authors.lastname: Castel
authors.forename: Irene
authors.initials: I
authors.lastname: Kuo
authors.forename: Meriam
authors.initials: M
authors.lastname: Mikre
authors.forename: Toni
authors.initials: T
authors.lastname: Young
authors.forename: Meredith
authors.initials: M
authors.lastname: Haddix
authors.forename: Suparna
authors.initials: S
authors.lastname: Das
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Maugham
authors.forename: Carol
authors.initials: C
authors.lastname: Reisen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003955:Diagnostic Tests, Routine; D004219:District of Columbia; D062665:Epidemiological Monitoring; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000628:therapy*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult