Evaluating testing strategies for identifying youths with HIV infection and linking youths to biomedical and other prevention services

Robin Lin Miller, Cherrie B. Boyer, Danielle Chiaramonte, Peter Lindeman, Kate Chutuape, Bendu Cooper-Walker, Bill G. Kapogiannis, Craig M. Wilson, J. Fortenberry

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

IMPORTANCE: Most human immunodeficiency virus (HIV)-infected youths are unaware of their serostatus (approximately 60%) and therefore not linked to HIV medical or prevention services. The need to identify promising and scalable approaches to promote uptake of HIV testing among youths at risk is critical. OBJECTIVE: To evaluate a multisite HIV testing program designed to encourage localized HIV testing programs focused on self-identified sexual minority males and to link youths to appropriate prevention services after receipt of their test results. DESIGN, SETTING, AND PARTICIPANTS: Testing strategieswere evaluated using an observational design during a 9-month period (June 1, 2015, through February 28, 2016). Testing strategies were implemented by 12 adolescent medicine HIV primary care programs and included targeted testing, universal testing, or a combination. Data were collected from local youth at high risk of HIV infection and, specifically, sexual minority males of color. MAIN OUTCOMES AND MEASURES: Proportion of sexual minority males and sexual minority males of color tested, proportion of previously undiagnosed HIV-positive youths identified, and rates of linkage to prevention services. RESULTS: A total of 3301 youths underwent HIV testing. Overall, 35 (3.6%) of those who underwent universal testing in primary care clinical settings, such as emergency departments and community health centers, were sexual minority males (35 [3.6%] were males of color) compared with 236 (46.7%) (201 [39.8%] were males of color) who were tested through targeted testing and 693 (37.8%) (503 [27.4%] were males of color) through combination efforts. Identification of new HIV-positive cases varied by strategy: 1 (0.1%) via universal testing, 39 (2.1%) through combination testing, and 16 (3.2%) through targeted testing. However, when targeted tests were separated from universal testing results for sites using a combined strategy, the rate of newly identified HIV-positive cases identified through universal testing decreased to 1 (0.1%). Rates of new HIV-positive cases identified through targeted testing increased to 49 (6.3%). Youths who tested through targeted testing (416 [85.1%]) were more likely to link successfully to local HIV prevention services, including preexposure prophylaxis, compared with those who underwent universal testing (328 [34.1%]). CONCLUSIONS AND RELEVANCE: The findings suggest that community-based targeted approaches to HIV testing are more effective than universal screening for reaching young sexual minority males (especially males of color), identifying previously undiagnosed HIV-positive youths, and linking HIV-negative youths to relevant prevention services. Targeted, community-based HIV testing strategies hold promise as a scalable and effective means to identify high-risk youths who are unaware of their HIV status.

Original languageEnglish (US)
Pages (from-to)532-537
Number of pages6
JournalJAMA Pediatrics
Volume171
Issue number6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Virus Diseases
HIV
Color
Primary Health Care
Adolescent Medicine
Community Health Centers

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Evaluating testing strategies for identifying youths with HIV infection and linking youths to biomedical and other prevention services. / Miller, Robin Lin; Boyer, Cherrie B.; Chiaramonte, Danielle; Lindeman, Peter; Chutuape, Kate; Cooper-Walker, Bendu; Kapogiannis, Bill G.; Wilson, Craig M.; Fortenberry, J.

In: JAMA Pediatrics, Vol. 171, No. 6, 01.06.2017, p. 532-537.

Research output: Contribution to journalArticle

Miller, RL, Boyer, CB, Chiaramonte, D, Lindeman, P, Chutuape, K, Cooper-Walker, B, Kapogiannis, BG, Wilson, CM & Fortenberry, J 2017, 'Evaluating testing strategies for identifying youths with HIV infection and linking youths to biomedical and other prevention services', JAMA Pediatrics, vol. 171, no. 6, pp. 532-537. https://doi.org/10.1001/jamapediatrics.2017.0105
Miller, Robin Lin ; Boyer, Cherrie B. ; Chiaramonte, Danielle ; Lindeman, Peter ; Chutuape, Kate ; Cooper-Walker, Bendu ; Kapogiannis, Bill G. ; Wilson, Craig M. ; Fortenberry, J. / Evaluating testing strategies for identifying youths with HIV infection and linking youths to biomedical and other prevention services. In: JAMA Pediatrics. 2017 ; Vol. 171, No. 6. pp. 532-537.
@article{5c72a2eb67f54f268884b3f7b945dab6,
title = "Evaluating testing strategies for identifying youths with HIV infection and linking youths to biomedical and other prevention services",
abstract = "IMPORTANCE: Most human immunodeficiency virus (HIV)-infected youths are unaware of their serostatus (approximately 60{\%}) and therefore not linked to HIV medical or prevention services. The need to identify promising and scalable approaches to promote uptake of HIV testing among youths at risk is critical. OBJECTIVE: To evaluate a multisite HIV testing program designed to encourage localized HIV testing programs focused on self-identified sexual minority males and to link youths to appropriate prevention services after receipt of their test results. DESIGN, SETTING, AND PARTICIPANTS: Testing strategieswere evaluated using an observational design during a 9-month period (June 1, 2015, through February 28, 2016). Testing strategies were implemented by 12 adolescent medicine HIV primary care programs and included targeted testing, universal testing, or a combination. Data were collected from local youth at high risk of HIV infection and, specifically, sexual minority males of color. MAIN OUTCOMES AND MEASURES: Proportion of sexual minority males and sexual minority males of color tested, proportion of previously undiagnosed HIV-positive youths identified, and rates of linkage to prevention services. RESULTS: A total of 3301 youths underwent HIV testing. Overall, 35 (3.6{\%}) of those who underwent universal testing in primary care clinical settings, such as emergency departments and community health centers, were sexual minority males (35 [3.6{\%}] were males of color) compared with 236 (46.7{\%}) (201 [39.8{\%}] were males of color) who were tested through targeted testing and 693 (37.8{\%}) (503 [27.4{\%}] were males of color) through combination efforts. Identification of new HIV-positive cases varied by strategy: 1 (0.1{\%}) via universal testing, 39 (2.1{\%}) through combination testing, and 16 (3.2{\%}) through targeted testing. However, when targeted tests were separated from universal testing results for sites using a combined strategy, the rate of newly identified HIV-positive cases identified through universal testing decreased to 1 (0.1{\%}). Rates of new HIV-positive cases identified through targeted testing increased to 49 (6.3{\%}). Youths who tested through targeted testing (416 [85.1{\%}]) were more likely to link successfully to local HIV prevention services, including preexposure prophylaxis, compared with those who underwent universal testing (328 [34.1{\%}]). CONCLUSIONS AND RELEVANCE: The findings suggest that community-based targeted approaches to HIV testing are more effective than universal screening for reaching young sexual minority males (especially males of color), identifying previously undiagnosed HIV-positive youths, and linking HIV-negative youths to relevant prevention services. Targeted, community-based HIV testing strategies hold promise as a scalable and effective means to identify high-risk youths who are unaware of their HIV status.",
author = "Miller, {Robin Lin} and Boyer, {Cherrie B.} and Danielle Chiaramonte and Peter Lindeman and Kate Chutuape and Bendu Cooper-Walker and Kapogiannis, {Bill G.} and Wilson, {Craig M.} and J. Fortenberry",
year = "2017",
month = "6",
day = "1",
doi = "10.1001/jamapediatrics.2017.0105",
language = "English (US)",
volume = "171",
pages = "532--537",
journal = "JAMA Pediatrics",
issn = "2168-6203",
publisher = "American Medical Association",
number = "6",

}

TY - JOUR

T1 - Evaluating testing strategies for identifying youths with HIV infection and linking youths to biomedical and other prevention services

AU - Miller, Robin Lin

AU - Boyer, Cherrie B.

AU - Chiaramonte, Danielle

AU - Lindeman, Peter

AU - Chutuape, Kate

AU - Cooper-Walker, Bendu

AU - Kapogiannis, Bill G.

AU - Wilson, Craig M.

AU - Fortenberry, J.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - IMPORTANCE: Most human immunodeficiency virus (HIV)-infected youths are unaware of their serostatus (approximately 60%) and therefore not linked to HIV medical or prevention services. The need to identify promising and scalable approaches to promote uptake of HIV testing among youths at risk is critical. OBJECTIVE: To evaluate a multisite HIV testing program designed to encourage localized HIV testing programs focused on self-identified sexual minority males and to link youths to appropriate prevention services after receipt of their test results. DESIGN, SETTING, AND PARTICIPANTS: Testing strategieswere evaluated using an observational design during a 9-month period (June 1, 2015, through February 28, 2016). Testing strategies were implemented by 12 adolescent medicine HIV primary care programs and included targeted testing, universal testing, or a combination. Data were collected from local youth at high risk of HIV infection and, specifically, sexual minority males of color. MAIN OUTCOMES AND MEASURES: Proportion of sexual minority males and sexual minority males of color tested, proportion of previously undiagnosed HIV-positive youths identified, and rates of linkage to prevention services. RESULTS: A total of 3301 youths underwent HIV testing. Overall, 35 (3.6%) of those who underwent universal testing in primary care clinical settings, such as emergency departments and community health centers, were sexual minority males (35 [3.6%] were males of color) compared with 236 (46.7%) (201 [39.8%] were males of color) who were tested through targeted testing and 693 (37.8%) (503 [27.4%] were males of color) through combination efforts. Identification of new HIV-positive cases varied by strategy: 1 (0.1%) via universal testing, 39 (2.1%) through combination testing, and 16 (3.2%) through targeted testing. However, when targeted tests were separated from universal testing results for sites using a combined strategy, the rate of newly identified HIV-positive cases identified through universal testing decreased to 1 (0.1%). Rates of new HIV-positive cases identified through targeted testing increased to 49 (6.3%). Youths who tested through targeted testing (416 [85.1%]) were more likely to link successfully to local HIV prevention services, including preexposure prophylaxis, compared with those who underwent universal testing (328 [34.1%]). CONCLUSIONS AND RELEVANCE: The findings suggest that community-based targeted approaches to HIV testing are more effective than universal screening for reaching young sexual minority males (especially males of color), identifying previously undiagnosed HIV-positive youths, and linking HIV-negative youths to relevant prevention services. Targeted, community-based HIV testing strategies hold promise as a scalable and effective means to identify high-risk youths who are unaware of their HIV status.

AB - IMPORTANCE: Most human immunodeficiency virus (HIV)-infected youths are unaware of their serostatus (approximately 60%) and therefore not linked to HIV medical or prevention services. The need to identify promising and scalable approaches to promote uptake of HIV testing among youths at risk is critical. OBJECTIVE: To evaluate a multisite HIV testing program designed to encourage localized HIV testing programs focused on self-identified sexual minority males and to link youths to appropriate prevention services after receipt of their test results. DESIGN, SETTING, AND PARTICIPANTS: Testing strategieswere evaluated using an observational design during a 9-month period (June 1, 2015, through February 28, 2016). Testing strategies were implemented by 12 adolescent medicine HIV primary care programs and included targeted testing, universal testing, or a combination. Data were collected from local youth at high risk of HIV infection and, specifically, sexual minority males of color. MAIN OUTCOMES AND MEASURES: Proportion of sexual minority males and sexual minority males of color tested, proportion of previously undiagnosed HIV-positive youths identified, and rates of linkage to prevention services. RESULTS: A total of 3301 youths underwent HIV testing. Overall, 35 (3.6%) of those who underwent universal testing in primary care clinical settings, such as emergency departments and community health centers, were sexual minority males (35 [3.6%] were males of color) compared with 236 (46.7%) (201 [39.8%] were males of color) who were tested through targeted testing and 693 (37.8%) (503 [27.4%] were males of color) through combination efforts. Identification of new HIV-positive cases varied by strategy: 1 (0.1%) via universal testing, 39 (2.1%) through combination testing, and 16 (3.2%) through targeted testing. However, when targeted tests were separated from universal testing results for sites using a combined strategy, the rate of newly identified HIV-positive cases identified through universal testing decreased to 1 (0.1%). Rates of new HIV-positive cases identified through targeted testing increased to 49 (6.3%). Youths who tested through targeted testing (416 [85.1%]) were more likely to link successfully to local HIV prevention services, including preexposure prophylaxis, compared with those who underwent universal testing (328 [34.1%]). CONCLUSIONS AND RELEVANCE: The findings suggest that community-based targeted approaches to HIV testing are more effective than universal screening for reaching young sexual minority males (especially males of color), identifying previously undiagnosed HIV-positive youths, and linking HIV-negative youths to relevant prevention services. Targeted, community-based HIV testing strategies hold promise as a scalable and effective means to identify high-risk youths who are unaware of their HIV status.

UR - http://www.scopus.com/inward/record.url?scp=85020737572&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020737572&partnerID=8YFLogxK

U2 - 10.1001/jamapediatrics.2017.0105

DO - 10.1001/jamapediatrics.2017.0105

M3 - Article

VL - 171

SP - 532

EP - 537

JO - JAMA Pediatrics

JF - JAMA Pediatrics

SN - 2168-6203

IS - 6

ER -