In 2012, over 1,200 HIV-positive patients accessed services at New York City’s (NYC) nine sexually transmitted disease (STD) clinics. Counseling, linkage, and social services are offered by medical providers and public health advisors at these facilities to help patients in need of HIV care services engage (or re-engage) in HIV primary care.
We matched data from the STD clinic electronic medical record and the NYC HIV/AIDS Surveillance Registry for HIV-positive persons who sought services at NYC STD clinics in 2012. We identified patients who were out of HIV care (<2 viral load [VL] or CD4 results) in the 365 days preceding their STD clinic visit and looked for subsequent evidence of HIV care ( ≥1 VL or CD4 result) within 3 months after the STD clinic visit. We compared patient characteristics (demographics, receipt of an HIV test on day of clinic visit, sexual risk behaviors, and STD diagnoses) among those with and without evidence of HIV care within 3 months after the STD clinic visit.
Among 378 out-of-care patients, 164 (43%) had evidence of HIV care during the 3 months after the STD clinic visit. Within 12 months, 99% (162/164) of these patients had a VL recorded (with 69% virally suppressed); of 214 patients who did not have evidence of HIV care during the 3 months after the STD clinic visit, 42% (90/214) had a VL within 12 months and 50% were virally suppressed (p<0.01 for VL report). Evidence of HIV care was more common among those who received an HIV test during their STD clinic visit (largely persons originally reported to the HIV Registry by a non-STD clinic provider in the year prior) than among those who did not receive an HIV test (66% vs. 40%, p<0.01). Evidence of HIV care following the STD clinic visit was also more common among Hispanic than non-Hispanic patients (51% vs. 41%, p=0.08) and women vs. men (67% vs 42%, p=0.02). Lack of evidence of HIV care did not differ significantly among persons reporting ≥5 sexual partners in 3 months prior to visit compared to those with <5 partners (69% vs. 57%, p=0.10), but was more common among patients diagnosed with gonorrhea on the day of the clinic visit than those not diagnosed (69% vs. 54%, p=0.03).
STD clinic visits provide an opportunity to link or re-link patients who may be unengaged in HIV care. Targeting patients less likely to access HIV care in the months after their visit may help reduce disparities in subsequent VL suppression and onward transmission.