New York City’s publicly funded sexually transmitted disease (STD) clinics provide a vital link to HIV care for many New Yorkers with newly diagnosed and prevalent HIV infection. In 2012, over 1,500 New Yorkers who were known to be HIV+ sought STD-related services; they were largely low-income, often uninsured, and black, and approximately 350 of them were newly diagnosed with HIV at these clinics that year.
HIV+ STD clinic patients are an important group with respect to preventing further HIV transmission. STD clinic patients known to have HIV infection receive counseling, linkage, and referrals to social services, aimed at facilitating initiation of and engagement in HIV care.
As part of the Focused Action towards Suppression and Stopping Transmission (FASST) study1, an analysis of 2012 STD clinic and HIV Surveillance Registry data that was recently presented at the Conference on Retroviruses and Opportunistic Infections (CROI) found that almost a third of HIV+ patients seen at STD clinics are not engaged in HIV care in the year prior to their STD clinic visits. Compared to those who were engaged in HIV care in the year prior to the STD clinic visit, patients not engaged were also less likely to have subsequent evidence of HIV care within 3 months after their STD clinic visit, or to achieve viral suppression within 12 months.
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Viral suppression within 12 months after the clinic visit was particularly low among patients diagnosed with 2 or more STDs during the visit; an important finding due to the risk of increased HIV shedding during co-infection with other STDs. Both persons of non-Hispanic Black race/ethnicity and those residing in a high-poverty neighborhood had a lower likelihood of being virally suppressed subsequent to the STD clinic visit.
There is potential for STD clinics to play a significant role in initial linkage or re-linkage of a substantial number of HIV+ New Yorkers to HIV care. Possible improvements aimed at systematic identification of patients not engaged in HIV care (e.g. via real-time access to HIV Surveillance Registry data) could facilitate NYC’s public STD clinics’ efforts to link patients to HIV care.
1Source: Tymejczyk O, Jamison K, Pathela P, Braunstein S, Schillinger J, and Nash D. Evidence of HIV Care Following STD Clinic Visits by Out-of-Care HIV-Positive Persons. 2016 Conference on Retroviruses and Opportunistic Infections (CROI)
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