From January 2002 to December 2004, there were 17,594 pretest counseling sessions and 16,750 HIV tests conducted. Almost 40% of tests took place in the UCC (n=6,632), 25% from inpatient floors (n=4,253), 17% at the Drop-In Center (n=2,920), 9% from the PCC (n=1,516), and 9% in the ED (n=1,427). Among 16,750 HIV tests, 258 (1.5%) were positive. Of the 258 patients who tested HIV positive, 29 reported a previous HIV-positive test result in their pretest counseling assessment and were excluded from analysis. (Patients who report their HIV status as positive in the UCC, PCC, inpatient floors, or Drop-In Center, but do not have any existing documentation, are tested to provide documentation and facilitate entry into care.) There were 15 indeterminate results and 10 unusable specimens (nine were quantity not sufficient and one was hemolyzed) that were excluded from analysis. Thus, 229 (1.37%; 95% confidence interval [CI] 1.20, 1.56) of 16,696 patients were newly diagnosed with HIV. HIV test results were from 9,404 (56.3%) OMT samples, 1,871 (11.2%) venous blood samples, and 5,421 (32.5%) rapid testing fingersticks (all conducted in 2004).
Among all patients tested, 59% of patients were male, the median age was 36 years, 39% were black, 23% were white, 19% were Hispanic, and 8% were Haitian (). HIV prevalence was similar in the UCC (1.5%), Drop-In Center (1.5%), inpatient floors (1.4%), and PCC (1.2%), and lower in the ED (0.6%). The proportion of male clients HIV tested was lowest in the ED (45%), while men comprised more than 60% of clients tested in the UCC and Drop-In Center. A greater proportion of ED and UCC patients were black, and a greater proportion of Drop-In Center and inpatient floor clients were white. Almost 60% of clients undergoing HIV testing on the inpatient floors were aged ≥40 years, compared with 32.8% in the UCC, 31.5% in the Drop-In Center, and 40.6% in the PCC. Behavioral risks were more prevalent among UCC and Drop-In Center patients (). Patients tested at the Drop-In Center were more likely to report same-sex intercourse, injection drug use, or sex with an HIV-positive person than patients at any other testing venue. Patients tested in the UCC were more likely to report sex under the influence of drugs or alcohol, or a history of STD in the past three years.
Overall patient demographics and HIV results by site of HIV test, 2002–2004
Patient risks by site of HIV test, 2002–2004a
HIV-positive test results by patient characteristics
Among demographic factors, patients who were male, aged 25 to 54, of non-white race other than Asian, uninsured, with less than a high school education, or referred for HIV testing by a physician were more likely to test HIV positive (). The prevalence of infection was greater than 2% among patients who were Haitian, Cape Verdean, uninsured, or had less than a high school education. HIV-positive results were more prevalent among patients who reported same-sex intercourse, history of STD, sex with an HIV-positive person, inconsistent condom use, or anal-receptive and anal-insertive intercourse. Other factors by which HIV test results did not differ (results not shown) were: sex under the influence of drugs or alcohol, sex with a commercial sex partner, sex in exchange for drugs or money, homelessness, and having a casual sex partner.
Number and percent HIV-positive test results by site and patient characteristics
The programmatic cost per HIV test and per previously unreported HIV infection was lowest in the UCC ($30.29 per HIV test and $1,980.00 per HIV-positive test result). The UCC had the highest HIV prevalence detected (1.5%), and also the greatest number of patients tested per eight-hour shift (6.3). While the Drop-In Center had the same HIV prevalence as the UCC, it had the lowest number of patients tested per eight-hour shift (2.8), contributing to its higher cost per HIV test ($68.74) and cost per HIV-positive test result ($4,652.00). Although the ED had a higher number of HIV tests per eight-hour shift (5.5) than inpatient (4.0), PCC (2.8), and the Drop-In Center (4.3), it had the lowest prevalence (0.6%) and highest cost per HIV-positive test result ($9,724) ().
Personnel costs and cost per HIV test and HIV-positive test result by sitea