Introduction
Understanding the role of sociologic, structural, and biomedical factors that influence
the length of time from HIV infection to diagnosis and reducing the time from infection
to diagnosis are critical for achieving the goals of the Ending the HIV Epidemic initiative.
In a retrospective analysis, the length of time from HIV infection to diagnosis and
its association with individual- and facility-level attributes are determined.
Methods
Data reported by December 2019 to the U.S. National HIV Surveillance System for people
with HIV diagnosed during 2014–2018 were analyzed during December 2020. A CD4 depletion
model was used to estimate the time from HIV infection to diagnosis.
Results
During 2018, the median time from HIV infection to diagnosis was shorter for those
infections diagnosed using the rapid testing algorithm (30.3 months, 95% CI=25.5,
34.5) than those diagnosed using the recommended (41.0 months, 95% CI=39.5, 42.0),
traditional (37.0 months, 95% CI=29.5, 43.5), or other (35.5 months, 95% CI=32.5,
38.0) diagnostic testing algorithms. From 2014 to 2018, the time from HIV infection
to diagnosis remained stable overall for all testing methods except for the traditional
diagnostic testing algorithm. In multivariate analyses, those more likely to have
HIV diagnosed closer to the time of infection were younger, were White, had transmission
risk factors of injection drug use or heterosexual contact (for female individuals)
or male-to-male sexual contact and injection drug use, or had HIV diagnosed at a correctional
or screening facility (p<0.01).
Conclusions
Providing access to expanded testing, including rapid testing in nonclinical settings,
is likely to result in a decrease in the length of time a person is unaware of their
HIV infection and thus reduce onward transmission of HIV infection.
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Article Info
Publication History
Published online: June 30, 2021
Identification
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Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
