Timeliness of HIV Diagnosis and Antiretroviral Treatment Initiation in the Era of Universal Test and Treat.

Abstract

BACKGROUND\nWe describe the timing of HIV diagnosis and antiretroviral treatment (ART) initiation following implementation of universal test and treatment policies in New York City (NYC).\n\n\nMETHODS\nUsing NYC population-based HIV Registry data for persons diagnosed from 2012 through 2015 and followed through June 2017, we examined trends in the proportion diagnosed early following HIV infection (i.e., with CD4 count ≥500 cells/mm or with acute HIV infection) and used Kaplan-Meier plots and proportional hazards regression to examine the timing of ART initiation following diagnosis.\n\n\nRESULTS\nAmong 9,987 NYC residents diagnosed with HIV from 2012-2015, 35% were diagnosed early and 87% initiated ART by June 2017. The annual proportion of persons diagnosed early did not increase appreciably (35% in 2012 versus 37% in 2015, p=0.08). By 6 months following diagnosis, 62%, 67%, 72% and 77% of persons diagnosed in 2012, 2013, 2014 or 2015, respectively, had initiated ART, with respective median time (months) to ART initiation of 3.34 (Interquartile range: 1.34-12.75), 2.62(1.28-10.13), 2.16(1.15-7.11), 2.03(1.11-5.61).\n\n\nCONCLUSIONS\nWhile recommendations for ART initiation upon diagnosis are increasingly being implemented, these finding suggest immediate treatment initiation is not universal. Continued efforts are needed to expand and better target HIV testing to promote earlier diagnosis.