scholarly journals Where Are the Newly Diagnosed HIV Positives in Kenya? Time to Consider Geo-Spatially Guided Targeting at a Finer Scale to Reach the “First 90”

2021 ◽  
Vol 9 ◽  
Author(s):  
Anthony Waruru ◽  
Joyce Wamicwe ◽  
Jonathan Mwangi ◽  
Thomas N. O. Achia ◽  
Emily Zielinski-Gutierrez ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Scan Statistics ◽  
Rank Test ◽  
Hiv Positive ◽  
Newly Diagnosed ◽  
Hiv Status ◽  
Aggregated Data ◽  
Hiv Testing Services ◽  
Facility Level ◽  
Global And Local

Background: The UNAIDS 90-90-90 Fast-Track targets provide a framework for assessing coverage of HIV testing services (HTS) and awareness of HIV status – the “first 90.” In Kenya, the bulk of HIV testing targets are aligned to the five highest HIV-burden counties. However, we do not know if most of the new HIV diagnoses are in these five highest-burden counties or elsewhere.Methods: We analyzed facility-level HTS data in Kenya from 1 October 2015 to 30 September 2016 to assess the spatial distribution of newly diagnosed HIV-positives. We used the Moran's Index (Moran's I) to assess global and local spatial auto-correlation of newly diagnosed HIV-positive tests and Kulldorff spatial scan statistics to detect hotspots of newly diagnosed HIV-positive tests. For aggregated data, we used Kruskal-Wallis equality-of-populations non-parametric rank test to compare absolute numbers across classes.Results: Out of 4,021 HTS sites, 3,969 (98.7%) had geocodes available. Most facilities (3,034, 76.4%), were not spatially autocorrelated for the number of newly diagnosed HIV-positives. For the rest, clustering occurred as follows; 438 (11.0%) were HH, 66 (1.7%) HL, 275 (6.9%) LH, and 156 (3.9%) LL. Of the HH sites, 301 (68.7%) were in high HIV-burden counties. Over half of 123 clusters with a significantly high number of newly diagnosed HIV-infected persons, 73(59.3%) were not in the five highest HIV-burden counties. Clusters with a high number of newly diagnosed persons had twice the number of positives per 1,000,000 tests than clusters with lower numbers (29,856 vs. 14,172).Conclusions: Although high HIV-burden counties contain clusters of sites with a high number of newly diagnosed HIV-infected persons, we detected many such clusters in low-burden counties as well. To expand HTS where most needed and reach the “first 90” targets, geospatial analyses and mapping make it easier to identify and describe localized epidemic patterns in a spatially dispersed epidemic like Kenya's, and consequently, reorient and prioritize HTS strategies.

scholarly journals Implementing Assisted Partner Services to HIV Test and Treat Men and their Female Sexual Partners: A Study Protocol (Preprint)

2021 ◽  
Author(s):  
Edward Kariithi ◽  
Monisha Sharma ◽  
Emily Kemunto ◽  
Harison Lagat ◽  
George Otieno ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Real World ◽  
Sexual Partners ◽  
Hiv Positive ◽  
Newly Diagnosed ◽  
Western Kenya ◽  
Hiv Testing Services ◽  
Male Sexual Partners ◽  
Female Index

BACKGROUND Despite the effective scale-up of HIV testing and treatment programs worldwide, only 75% of persons living with HIV (PLWH) globally know their status, with lower rates among men. This highlights the importance of implementing HIV testing and linkage interventions with high uptake in this population group. In a cluster randomized controlled trial conducted between 2013 and 2015, our team found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH, safely reached more at-risk individuals to conduct testing compared to client referral alone. However, more data is needed to assess APS implementation in a real-world setting. OBJECTIVE This study evaluates the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya. METHODS In a collaboration between the University of Washington and PATH, we are integrating APS into 31 health facilities in Western Kenya and enrolling female index clients newly diagnosed with HIV who receive APS, their male sexual partners, and female sexual partners of the male sexual partners who test HIV positive. Female index clients and all sexual partners testing HIV-positive will be followed up at 6 weeks, 6 months, and 12 months to assess linkage to care, antiretroviral therapy (ART) initiation, and HIV viral load suppression. We will evaluate acceptability, fidelity and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and sub-county level policymakers responsible for HIV testing services. Facility health staff providing HIV testing services and APS, in addition to staff working with the study project team will also be interviewed. We will also conduct direct observations of facility infrastructure and clinic procedures, and extract data from facility and county/national databases. RESULTS As of March 2020, we have recruited 1724 index clients, 3201 male partners, and 1585 female partners. We have completed all recruitment for this study and have completed all 6-week (99%), 6-month (97%) and 12-month (91%) follow-up visits. Preliminary analyses demonstrate that through scaling-up APS, facilities are able to identify 12-18 new HIV-positive males for every 100 men contacted and tested. We are now in the process of completing the remaining follow-up interviews and building a self-testing component of the study as an adaptation to the COVID-19 pandemic. CONCLUSIONS Results will be used to bridge the gap between clinical research findings and everyday practice, and provide guidance on optimal strategies for APS integration into HIV service delivery. CLINICALTRIAL N/A

Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

2017 ◽  
Vol 94 (3) ◽  
pp. 194-199 ◽  
Author(s):  
James Blain Johnston ◽  
Joss N Reimer ◽  
John L Wylie ◽  
Jared Bullard
Keyword(s):  
Viral Load ◽  
Hiv Testing ◽  
Clinical Outcomes ◽  
Point Of Care ◽  
Age Groups ◽  
Linkage To Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Viral Load Suppression ◽  
Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

scholarly journals Social Support and Violence-prone Relationships as Predictors of Disclosure of HIV Status Among Newly Diagnosed HIV-positive South Africans

2018 ◽  
Vol 22 (10) ◽  
pp. 3287-3295 ◽  
Author(s):  
Jocelyn Fifield ◽  
Lucia O’Sullivan ◽  
Elizabeth A. Kelvin ◽  
Joanne E. Mantell ◽  
Theresa Exner ◽  
...  
Keyword(s):  
Social Support ◽  
Hiv Positive ◽  
Newly Diagnosed ◽  
Hiv Status ◽  
South Africans

scholarly journals Formative research to inform the development of a peer-led HIV self-testing intervention to improve HIV testing uptake and linkage to HIV care among adolescents, young people and adult men in Kasensero fishing community, Rakai, Uganda: a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Joseph K. B. Matovu ◽  
Aminah Nambuusi ◽  
Scovia Nakabirye ◽  
Rhoda K. Wanyenze ◽  
David Serwadda
Keyword(s):  
Young People ◽  
Hiv Testing ◽  
Hiv Care ◽  
Hiv Positive ◽  
Fishing Community ◽  
Adult Men ◽  
Self Testing ◽  
Testing Uptake ◽  
Hiv Testing Services ◽  
Linkage To Hiv Care

Abstract Background Despite efforts to improve HIV testing and linkage to HIV care among adolescents, young people and adult men, uptake rates remain below global targets. We conducted formative research to generate data necessary to inform the design of a peer-led HIV self-testing (HIVST) intervention intended to improve HIV testing uptake and linkage to HIV care in Kasensero fishing community in rural Uganda. Methods This qualitative study was conducted in three study communities in Kasensero fishing community in Rakai district, Uganda, in May 2019. Six single-sex focus group discussions (FGDs) comprising 7–8 participants were conducted with adolescents and young people (15–24 years) and adult men (25+ years). We collected data on people’s perceptions about peer-led HIVST; potential acceptability of a peer-led HIVST intervention and suggestions on how to improve linkage to HIV care after a positive HIVST result. Peer-led HIVST was defined as an approach where trained lay people distribute HIVST kits to other people in the community. FGDs were audio-recorded with permission from the participants, transcribed verbatim and analysed manually following a thematic framework approach. Results Forty-seven participants (31 men and 16 women) participated in the FGDs. Across communities and age-groups, most participants mentioned that peer-led HIVST would be generally acceptable to people in the fishing community but people will need support in performing the test due to fear of performing the test wrongly or failing to cope with HIV-positive results. Most participants felt that peer-led HIVST would bring HIV testing services closer to the community “because [the peer-leader] could be my immediate neighbour”, making it easier for people to obtain the kits at any time of their convenience. To improve linkage to HIV care, participants felt that the use of peer-leaders to deliver the initial ART dose to self-tested HIV-positive individuals would be more preferable to the use of community-based ART groups or home-based ART initiation. Conclusion Our study shows that peer-led HIVST is potentially acceptable in the fishing community. These findings suggest that this approach can improve uptake of HIV testing and linkage to HIV care services among populations that are usually missed through conventional HIV testing services.

Clinical and laboratory characteristics of ocular syphilis and neurosyphilis among individuals with and without HIV infection

2020 ◽  
Vol 105 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Dony Mathew ◽  
Derrick Smit
Keyword(s):  
Hiv Infection ◽  
Posterior Uveitis ◽  
Intraocular Inflammation ◽  
Hiv Positive ◽  
Newly Diagnosed ◽  
Hiv Status ◽  
Ocular Syphilis ◽  
Bilateral Involvement ◽  
Frequent Form ◽  
Hiv Coinfection

Background/aimsIn the era of increasing incidence of syphilis globally, ocular syphilis is re-emerging as an important cause of uveitis. The aim of this study was to determine the clinical and laboratory characteristics of ocular- and neurosyphilis among individuals with and without HIV infection.MethodsRetrospective analysis of patients diagnosed with ocular syphilis presenting to Tygerberg Hospital, South Africa, over a 5-year period ending December 2018.ResultsTwo-hundred and fifteen eyes of 146 patients were included. HIV coinfection was present in 52.1% of the patients, with 23.7% of these patients being newly diagnosed on presentation. The median age was 36.5±9.8 years. Bilateral involvement occurred in 47.3%, with 68.1% of these patients being HIV positive. The most frequent form of intraocular inflammation was posterior uveitis (40.9%), followed by panuveitis (38.1%), both of which were more predominant in HIV-positive eyes. Seventy-four per cent of all eyes had a visual acuity ≤20/50 and 40% <20/200 at presentation. A lumbar puncture was performed in 113 patients (77.4%). Sixteen patients had confirmed neurosyphilis and 27 probable neurosyphilis according to the UpToDate algorithms.ConclusionThis study included the largest number of ocular syphilis cases with the largest proportion of HIV infection to date. Forty-three of 146 patients (37.0%) had neurosyphilis. HIV status must be determined in all patients with ocular syphilis since almost ¼ of patients were newly diagnosed with HIV infection by doing so.

Treatment Of Primary Central Nervous System Lymphoma In The HIV-Positive Patient: Should We Be Doing More?

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4362-4362
Author(s):  
Jeremy Clifton Jones ◽  
Harris V. Naina ◽  
Yu-Min P Shen
Keyword(s):  
Overall Survival ◽  
Survival Data ◽  
Central Nervous System Lymphoma ◽  
Rank Test ◽  
Hiv Positive ◽  
Immunocompromised Patients ◽  
Hiv Status ◽  
Tumor Registry ◽  
Log Rank Test ◽  
Hiv Negative

Abstract Background Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non Hodgkin lymphoma, accounting for approximately 3-4% of new primary brain tumors and approximately 1% of all NHL. The overall incidence of PCNSL is approximately 0.43/100,000 per year, but the relative risk of disease among immunocompromised patients is considerably higher; approximately 3600 times that of the general population. Similarly, the average age of onset, race, treatment regimens and overall survival are all markedly different amongst immunocompetent and immunocompromised patients with PCNSL. The standard treatment for immunocompetent includes high-dose methotrexate based regimens with or without whole brain radiation therapy (WBRT). On the contrary, there is little to no prospective data guiding the treatment of immunocompromised patients with PCNSL. The standard therapy for these patients has yet to be defined, leaving the majority to receive the potentially sub-optimal regimens including WBRT in addition to highly active antiretroviral therapy (HAART). The current study reports on survival data from a retrospective cohort of patients with biopsy-proven PCNSL diagnosed at our institution over the last decade stratified by both HIV status and therapy received. Methods Parkland Memorial Hospital is a 950-bed acute care hospital located in Dallas, Texas. It serves as the county hospital for the city of Dallas as well as the primary teaching site of the University of Texas Southwestern Medical Center. After approval by the institutional review board, we identified patients with biopsy proven PCNSL between 1998 and 2012 at Parkland Memorial Hospital through the institution's tumor registry. After patient identification, the medical records were reviewed for the following patient data: age at diagnosis, ethnicity, sex, HIV status, CD4 cell count, HIV viral load, neuroimaging, treatment (radiation therapy and/or chemotherapy), date of death and date of last contact. Survival data and date of death were obtained from our tumor registry, chart reviews, and social security death index searches. Kaplan–Meier survival curves were constructed and compared between the two groups using the log rank test. Results 40 HIV-positive and 21 HIV-negative patients were included in this retrospective analysis. PCNSL was diagnosed by histological evaluation of biopsy specimens in all 61 patients. Patients were stratified based on their HIV status. Baseline demographic information for the two groups is compared in table 1. Median survival was 21.3 months and 4.6 months for the HIV-negative and HIV-positive cohorts respectively. All HIV-negative patients were treated with HD-MTX based regimens in addition to WBRT (MTX+RT). Of the HIV-positive patients: 28 received WBRT plus HAART (RT+HAART), 7 received no treatment and 5 received HD-MTX based regimens plus WBRT and HAART (MTX+RT+HAART). The average CD4 count at diagnosis in patients who did not receive treatment was 9.1, 50.6 in those who received RT+HAART and 155.8 in those who received MTX+RT+HAART although these differences did not meet statistical significance (p=0.056), (Table 2). HIV-positive patients who received RT+HAART had significantly better overall survival (OS) than those who received no treatment (p-value of log-rank test 0.00023) but worse OS than those who received MTX+RT+HAART (p= 0.0121). There was no difference in OS between HIV-positive patients who received MTX+RT+HAART and HIV-negative patients who received MTX+RT (p= 0.778), (figure 1). Conclusions The data from our current study suggests HIV-positive patients with PCNSL can achieve similar overall survival as their HIV-negative counterparts when they receive similar chemotherapeutic regimens. Furthermore, RT+HAART appears to offer inferior OS to MTX+RT+HAART despite similar baseline CD4 counts. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Trends in knowledge of HIV status and efficiency of HIV testing services in Sub-Saharan Africa (2000-2020): a modelling study of survey and HIV testing program data

2020 ◽  
Author(s):  
Katia Giguère ◽  
Jeffrey W. Eaton ◽  
Kimberly Marsh ◽  
Leigh F. Johnson ◽  
Cheryl C. Johnson ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Median Time ◽  
Credible Interval ◽  
Population Based ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Hiv Testing Services ◽  
Sub Saharan ◽  
First Time

AbstractBackgroundKnowledge of HIV status (KOS) among people living with HIV (PLHIV) is essential for an effective national HIV response. This study estimates progress and gaps in reaching the UNAIDS 2020 target of 90% KOS, and the efficiency of HIV testing services (HTS) in sub-Saharan Africa (SSA), where two thirds of all PLHIV live.MethodsWe used data from 183 population-based surveys (N=2.7 million participants) and national HTS programs (N=315 country-years) from 40 countries as inputs into a mathematical model to examine trends in KOS among PLHIV, median time from HIV infection to diagnosis, HIV testing positivity, and proportion of new diagnoses among all positive tests, adjusting for retesting.FindingsAcross SSA, KOS steadily increased from 6% (95% credible interval [95%CrI]: 5% to 7%) in 2000 to 84% (95%CrI: 82% to 86%) in 2020. Twelve countries and one region, Southern Africa, reached the 90% target. In 2020, KOS was lower among men (79%) than women (87%) across SSA. PLHIV aged 15-24 years were the least likely to know their status (65%), but the largest gap in terms of absolute numbers was among men aged 35-49 years, with over 700,000 left undiagnosed. As KOS increased from 2000 to 2020, the median time to diagnosis decreased from 10 to 3 years, HIV testing positivity declined from 9% to 3%, and the proportion of first-time diagnoses among all positive tests dropped from 89% to 42%.InterpretationOn the path towards the next UNAIDS target of 95% diagnostic coverage by 2030, and in a context of declining positivity and yield of first-time diagnoses, we need to focus on addressing disparities in KOS. Increasing KOS and treatment coverage among older men could be critical to reduce HIV incidence among women in SSA, and by extension, reducing mother-to-child transmission.

scholarly journals Understanding the association between caregiver sex and HIV infection among orphans and vulnerable children in Tanzania: Learning from the USAID Kizazi Kipya Project

2020 ◽  
Author(s):  
Amon Exavery ◽  
John Charles ◽  
Erica Kuhlik ◽  
Asheri Barankena ◽  
Alison Koler ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Hiv Testing ◽  
Hiv Risk ◽  
Urban Areas ◽  
Hiv Positive ◽  
Hiv Status ◽  
Vulnerable Children ◽  
Orphans And Vulnerable Children ◽  
Male Caregivers ◽  
Hiv Risk Assessment

Abstract Background Tanzania has met only 50.1% of the 90% target for diagnosing HIV in children. Context-specific strategies are necessary to find the hidden children for HIV testing. This study assesses the association between caregiver sex and HIV status of orphans and vulnerable children (OVC). Methods Data originate from the community-based, USAID-funded Kizazi Kipya Project, which works towards increasing OVC’s and their caregivers’ uptake of HIV/AIDS and other social services in Tanzania. Included in this study are 39,578 OVC ages 0–19 years who the project served during January-March 2017 in 18 regions of Tanzania and who voluntarily reported their HIV status. Data analysis involved multi-level logistic regression, with OVC HIV status as the outcome and caregiver’s sex the main independent variable. Results Three-quarters (74.3%) of the OVC included in the study had female caregivers, and their overall HIV prevalence was 7.1%. The prevalence was significantly higher (p<0.001) among OVC with male caregivers (7.8%) than among OVC with female caregivers (6.8%), and indeed, multivariate analysis showed that OVC with male caregivers were significantly 40% more likely to be HIV-positive than those with female caregivers (OR=1.40, 95% CI 1.08–1.83). This effect was the strongest among 0–4 year-olds (OR=4.02, 95% CI 1.61–10.03), declined to 1.72 among 5–9 year-olds (OR=1.72, 95% CI 1.02–2.93), and lost significance for children over age 9 years. This effect was adjusted for OVC sex and nutritional status; caregiver marital status, education level, and HIV status; family’s place of residence, size, wealth quintile, and health insurance ownership; and co-residence of multiple OVC. Conclusion OVC in Tanzania with male caregivers have a 40% higher likelihood of being HIVpositive than those with female caregivers. HIV risk assessment activities should target OVC with male caregivers, as well as OVC who have malnutrition, HIV-positive caregivers, or caregivers who do not disclose their HIV status to community volunteers. Further, younger HIV-positive OVC are more likely to live in rural areas, while older HIV-positive OVC are more likely to live in urban areas. These factors should be integrated in HIV risk assessment algorithms to enhance HIV testing yields and pediatric case-finding in the OVC population in Tanzania.

scholarly journals Closing the pediatric gap in the first 90: is caregiver sex associated with HIV status of orphans and vulnerable children? Learning from the USAID Kizazi Kipya Project in Tanzania

2019 ◽  
Author(s):  
Amon Exavery ◽  
John Charles ◽  
Erica Kuhlik ◽  
Asheri Barankena ◽  
Alison Koler ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Hiv Testing ◽  
Hiv Risk ◽  
Urban Areas ◽  
Hiv Positive ◽  
Hiv Status ◽  
Vulnerable Children ◽  
Orphans And Vulnerable Children ◽  
Male Caregivers ◽  
Hiv Risk Assessment

Abstract Background Tanzania has met only 50.1% of the 90% target for diagnosing HIV in children. Context-specific strategies are necessary to find the hidden children for HIV testing. This study assesses the association between caregiver sex and HIV status of orphans and vulnerable children (OVC). Methods Data originate from the community-based, USAID-funded Kizazi Kipya Project, which works towards increasing OVC’s and their caregivers’ uptake of HIV/AIDS and other social services in Tanzania. Included in this study are 39,578 OVC ages 0–19 years who the project served during January-March 2017 in 18 regions of Tanzania and who voluntarily reported their HIV status. Data analysis involved multi-level logistic regression, with OVC HIV status as the outcome and caregiver’s sex the main independent variable.Results Three-quarters (74.3%) of the OVC included in the study had female caregivers, and their overall HIV prevalence was 7.1%. The prevalence was significantly higher (p<0.001) among OVC with male caregivers (7.8%) than among OVC with female caregivers (6.8%), and indeed, multivariate analysis showed that OVC with male caregivers were significantly 40% more likely to be HIV-positive than those with female caregivers (OR=1.40, 95% CI 1.08–1.83). This effect was the strongest among 0–4 year-olds (OR=4.02, 95% CI 1.61–10.03), declined to 1.72 among 5–9 year-olds (OR=1.72, 95% CI 1.02–2.93), and lost significance for children over age 9 years. This effect was adjusted for OVC sex and nutritional status; caregiver marital status, education level, and HIV status; family’s place of residence, size, wealth quintile, and health insurance ownership; and co-residence of multiple OVC. Conclusion OVC in Tanzania with male caregivers have a 40% higher likelihood of being HIVpositive than those with female caregivers. HIV risk assessment activities should target OVC with male caregivers, as well as OVC who have malnutrition, HIV-positive caregivers, or caregivers who do not disclose their HIV status to community volunteers. Further, younger HIV-positive OVC are more likely to live in rural areas, while older HIV-positive OVC are more likely to live in urban areas. These factors should be integrated in HIV risk assessment algorithms to enhance HIV testing yields and pediatric case-finding in the OVC population in Tanzania.

Estimation of the Percentage of Newly Diagnosed HIV-Positive Persons Linked to HIV Medical Care in CDC-Funded HIV Testing Programs

2017 ◽  
Vol 41 (4) ◽  
pp. 474-492 ◽  
Author(s):  
Guoshen Wang ◽  
Yi Pan ◽  
Puja Seth ◽  
Ruiguang Song ◽  
Lisa Belcher
Keyword(s):  
Medical Care ◽  
Hiv Testing ◽  
Multiple Imputation ◽  
Missing Values ◽  
Complete Information ◽  
Current Approach ◽  
Hiv Positive ◽  
Linkage Data ◽  
Newly Diagnosed ◽  
Data Set

Missing data create challenges for determining progress made in linking HIV-positive persons to HIV medical care. Statistical methods are not used to address missing program data on linkage. In 2014, 61 health department jurisdictions were funded by Centers for Disease Control and Prevention (CDC) and submitted data on HIV testing, newly diagnosed HIV-positive persons, and linkage to HIV medical care. Missing or unusable data existed in our data set. A new approach using multiple imputation to address missing linkage data was proposed, and results were compared to the current approach that uses data with complete information. There were 12,472 newly diagnosed HIV-positive persons from CDC-funded HIV testing events in 2014. Using multiple imputation, 94.1% (95% confidence interval (CI): [93.7%, 94.6%]) of newly diagnosed persons were referred to HIV medical care, 88.6% (95% CI: [88.0%, 89.1%]) were linked to care within any time frame, and 83.6% (95% CI: [83.0%, 84.3%]) were linked to care within 90 days. Multiple imputation is recommended for addressing missing linkage data in future analyses when the missing percentage is high. The use of multiple imputation for missing values can result in a better understanding of how programs are performing on key HIV testing and HIV service delivery indicators.

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