Last Updated: 17 Jun 2016

Greta L Anschuetz, MPH

Use of STD Clinic surveillance for program

evaluation – Philadelphia

Philadelphia Department of Public Health

• Operates 2 categorical STD Clinics

- Health Center #1

• Located in the heart of Center City, near public transportation

• Open until 7pm on Monday and Wednesday nights, otherwise,

7:45-4:15, Monday-Friday

- Health Center #5, Team C

• Located in North Philadelphia

• Co-located with on of the full medical/dental health clinics

operated by PDPH

• Open 8:30-4pm, Monday-Friday

2015 Visits to STD Clinics

14116

6431

Health Center #1 Visits

Males

Females 3309

2738

Health Center #5 Visits

Males

Females

Total: 26,594

STD Clinic Demographics by Patients

Demographics of all patients

HIV Status among MSM

HIV Status among MSW

Confirming care status/linkage to care

• Clinic and STD Control does not have direct access to eHARS

• Rely on patient report of status and care

- Social worker staff at HC1 have a protocol to confirm care status for each HIV+ individual

• Not well tracked

• What is the protocol for when they are not in care???

- How well does this work?

• Data for 2015 were extract and sent to eHARS asking for:

– Last viral load BEFORE clinic visit

– First viral load AFTER clinic visit

HIV and Care Status

488 individuals either self-reported positive OR one lab

test positive

17 Not in HARS

6 False Positives11 OOJ or live here

now

471 in HARS

298 had a viral load before AND after

their visit

87 had a viral load AFTER their visit

only

69 had a viral load BEFORE their visit

only

17 had no viral load BEFORE OR

AFTER their visit

When is the last/next viral load compared to visit date?

Last Viral Load Before Visit Next Viral Load After Visit

0-30 days 85 (20%) 97 (23%)

31-90 days 104 (25%) 107 (26%)

91-180 days 82 (20%) 89 (21%)

181+ 93 (22%) 43 (10%)

No viral load 53 (13%) 81 (19%)

63% (298/471) had a viral load both before and after their visit

Among patients diagnosed with HIV (N=417) before their visit:

Of note, of the 53 (13%) without a viral load prior to their STD Clinic visit, 41

(77%) ultimately had a viral load and 29 of those had a viral load within 30

days of their STD Clinic visit!

Of 54 new infections diagnosed at their STD Clinic visit, 39 (72%) had a viral

load within 30 days and 10 (19%) having a viral load 30+ days from visit

Viral loads

• Further evaluation of the 189 with viral loads 90 days before their clinic visit showed

- 139 (74%) ultimately had a suppressed viral load (<200)

- 11 (6%) had a viral load between 200-5,000

- 19 (10%) had a viral load >5,000

- 11% (20/189) have not had a subsequent viral load

• Further evaluation of the 93 with a viral load more than 180 days before their clinic visit showed

- 31 (33%) ultimately had a suppressed viral load (<200)

- 4 (4%) had a viral load between 200-5,000

- 20 (22%) had a viral load >5,000

- 41% (38/93) have not had a subsequent viral load

Using Alere Determine HIV ½ Ag/Ab Combo

• Started in January 2016

- First month, we had 4 results where the Alere rapid was positive, but

the Architect Ag/Ab was negative

- We then had 1 where the Alere rapid was negative, but we had Ag/Ab

& Multispot results from an outside lab already and our lab confirmed

the Ag/Ab & Multispot results

- Since late February, we have had 3 discordant results

• Alere rapid positive, Architect Ag/Ab positive, and Multispot neither 1 or 2

• We brought back patients for NAAT viral load testing

• 1 acute HIV infection found!

- Typically run ~40 Alere results per day

Evaluation of PrEP

• How many enrolled?

• How many started meds?

• Retention rate

- How many have subsequent visits?

- How many are transitioned elsewhere for PrEP?

• Describe those lost to PrEP

- Have 16-17 people who started, but have missed visits

• How much time is spent trying to get meds for patients

• New to us, so we are open to suggestions

Conclusions

• 63% (298/471) of HIV+ patients had a viral load before and after their visit to our STD Clinics

- Using eHARS could increase focus on patients most in need of

linkage to care

• Median viral load is undetectable, suggesting our clinics are used for urgent care issues

• Moving from a 2nd generation HIV test to a 4th generation has taught us to respect the result “preliminary positive”

- Will continue to monitor false positive to acute infection ratio

• PrEP Clinic is new to us and I would love feed to know how others are evaluating their PrEP clinics!