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Matthew B. Feldman, Ph.D., MSW Gay Men ’ s Health Crisis Elwin Wu, Ph.D.

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. The “ test ” and “ treat ” initiative.

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Matthew B. Feldman, Ph.D., MSW Gay Men ’ s Health Crisis Elwin Wu, Ph.D.

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  1. 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

  2. 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)

  3. 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

  4. 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)

  5. 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) • Sexual exchange • Visit reason • HIV testing history • STD symptoms/diagnosis • HIV testing site • Age • Gender • Race • Education • Substance use • Sexual risk behavior

  6. Receive Negative Result ? Receive Preliminary Positive Result Refuse Confirmatory Test Do not receive Confirmatory Result Receive Positive Confirmatory Result The missing link between “test” and “treat” in rapid HIV testing Rapid Test Treatment

  7. 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

  8. Understanding returning for confirmatory HIV test results: The Behavioral Model of Health Services Use (Andersen et al., 2000)

  9. 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

  10. Sample Tested for HIV (n= 9234) HIV-positive (n= 372, 4%) Indeterminate (n= 4, 0.0%) HIV-negative (n= 8853, 95.9%) False Positive (n= 5, 0.1%) Known Positives (n= 97, 26%) Newly diagnosed HIV-positive (n= 275, 74%) Refused Confirmatory HIV testing (n= 39, 14%) Returned for HIV confirmatory test results (n= 153, 56%) Did not return for HIV confirmatory test results (n= 83, 30%)

  11. Results:Predisposing factors

  12. Results:Predisposing factors

  13. Results:Enabling and Need Factors

  14. Results

  15. Conclusion • 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

  16. Discussion • First study to examine the correlates of returning for confirmatory test results • Limitations

  17. Implications and Next Steps • 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?

  18. Acknowledgments • Lynnette Ford • Stephen Hile • Blakeley Lowry • Moira Mendoza • Jeff Rindler matthewf@gmhc.org

  19. Results:Predisposing factors

  20. Results:Predisposing factors

  21. Results:Enabling and Need Factors

  22. Results

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