Predictors of Late Diagnosis for People Newly Diagnosed with HIV Infection in NSW.

Epidemiologist Barbara Telfer presented the findings of a cross sectional study which used NSW HIV notification data to identify predictors of late diagnosis.  Of the potential risk factors examined, the study found the following four factors to be associated with late diagnosis:

• ·         being over 50 years of age
• ·         being  female
• ·         being born outside Australia
• ·         residing in regional /rural areas

Late diagnosis is an important problem because it delays treatment, enables ongoing transmission, and can lead to poorer health outcomes.  If we are to continue progression towards virtual elimination, we need to identify the more elusive gaps in detection.

The study included data from 1465 notifications between January 2013 and June 2017, of which 38% (550) were considered late notifications. Late notification was defined as a CD4 count of less than 350 or an AIDS defining illness or death within 3 months of diagnosis, in the absence of a negative HIV test in the preceding 12 months.

Barbara noted that the study relied on data provided by the clinician giving the notification.  Some notifications could not be included due to missing information, which draws attention to the need for accurate data collection.

The study concluded that greater efforts needed to be made in the earlier detection of HIV amongst the groups found to be at high risk. The findings highlight the need for testing efforts to be inclusive of those who may not readily identify as needing a screen, to think both broadly about testing, and to be aware of those patients who we may have neglected to consider in terms of their risk. It is also a reminder for those clinicians working in rural and regional areas that they may be key players in earlier detection.