Indicators of HIV Risk in HIV-negative Persons at High Risk for HIV - Epi Profile Section 8

Epi Profile Section 8 - Indicators of HIV Risk in HIV-negative Persons at High Risk for HIV

This section describes public health testing programs funded by the Texas Department of State Health Services (DSHS). DSHS funds two types of HIV testing programs:  focused testing programs and routine testing programs in medical care settings. Funded providers either work with populations who carry a high burden of HIV or offer testing through their broader health services in areas and settings likely to serve low income and uninsured people. 

The program profiles and outcomes are shown in Table 22. The first set of columns for each program show the number and proportion of tests for various groups of clients. The second set of columns show the number of positive test results within groups of clients and the positivity rate, which is the number of clients with positive test results for every hundred clients tested. The final set of columns shows the number of diagnoses and diagnosis rate. Some of the clients with positive test results had been previously diagnosed. The diagnosis columns show only those clients who were newly diagnosed by the testing program. 

Focused Testing Programs

Focused testing sites offer HIV testing to persons at highest risk for HIV, such as MSM. These programs are carried out by community-based organizations and some local health departments. To be effective, these programs should have client profiles like the profile of Texans with new diagnoses. We also expect a diagnosis rate that is higher than the diagnosis rate for Texans overall (0.016%). [16] 

The focused testing client profile shows the following: 

  • Two-thirds of the tests were for men; 

  • 70% of the tests were for Black or Hispanic clients; 

  • 3 out of 5 tests were for clients younger than 35 years old; 

  • 72% of the tests were for clients in the areas with the greatest number of PLWH—Austin, Dallas, Fort Worth, Houston, and San Antonio; and 

  • 1 in 3 of the tests were for MSM. 

391 clients were diagnosed through the focused program in 2018. The diagnosis rate was 0.8%, which was 47 times higher than the overall diagnosis rate.

Routine HIV Testing in Health Care Settings

Routine testing programs test all clients in a medical care setting unless they decline. The testing is not based on individual patient risk. These programs are carried out in hospital emergency departments in areas with higher numbers of people living with HIV. A small number of tests in this program are conducted in primary care settings. Since all clients in a setting are tested, risk information is usually not collected by routine testing programs and is not shown in the tables below. 

The routine testing client profile shows the following: 

  • More than half of the tests were for women; 

  • Almost 70% of the tests were for Black or Hispanic clients; 

  • 36% of the tests were for clients younger than 35 years old; and 

  • Almost 90% of the tests were for clients in the areas with the greatest number of PLWH and new diagnoses—Austin, Dallas, Fort Worth, and Houston. 

293 clients were diagnosed through the focused program in 2018. The diagnosis rate was 0.1%, which was 8 times higher than the overall diagnosis rate in the general population. 

Table 22a: Profiles of HIV testing programs funded by DSHS in 2018

 

Focused Testing Programs 

 

Tests 

All positive 
tests 

Only new 
diagnoses 

 

Number 

% of 
tests 

Number 

Positive 
rate 

Number 

Diagnosis 
rate 

Total 

51,952 

 

637 

1.2% 

391 

0.8% 

Sex 

 

 

 

 

 

 

Men 

34,211 

66% 

555 

1.6% 

352 

1.0% 

Women 

17,307 

33% 

68 

0.4% 

34 

0.2% 

Transgender women 

362 

1% 

14 

3.9% 

1.4% 

Transgender men 

11 

0% 

0.0% 

0.0% 

Unknown 

61 

0% 

0% 

0% 

Race/Ethnicity 

 

 

 

 

 

 

White 

13,062 

25% 

118 

0.9% 

76 

0.6% 

Black 

15,290 

29% 

219 

1.4% 

122 

0.8% 

Hispanic 

21,081 

41% 

271 

1.3% 

178 

0.8% 

Other 

2,071 

4% 

23 

1.1% 

12 

0.6% 

Multi-race 

448 

1% 

1.3% 

0.7% 

Age group (years) 

 

 

 

 

 

 

0-14 

62 

0% 

1.6% 

0% 

15-24 

14,109 

27% 

148 

1.0% 

107 

0.8% 

25-34 

18,853 

36% 

269 

1.4% 

170 

0.9% 

35-44 

9,468 

18% 

123 

1.3% 

73 

0.8% 

45-54 

5,501 

11% 

67 

1.2% 

31 

0.6% 

55-64 

3,077 

6% 

22 

0.7% 

0.3% 

65+ 

851 

2% 

0.8% 

0.2% 

Unknown 

51 

0% 

0% 

0% 

Geography 

 

 

 

 

 

 

Austin TGA 

4,776 

9% 

28 

0.6% 

21 

0.4% 

Dallas EMA 

9,991 

19% 

192 

1.9% 

99 

1.0% 

Fort Worth TGA 

5,596 

11% 

67 

1.2% 

50 

0.9% 

Houston EMA 

5,158 

10% 

55 

1.1% 

37 

0.7% 

San Antonio TGA 

11,728 

23% 

126 

1.1% 

68 

0.6% 

Rest of Texas 

14,703 

28% 

169 

1.1% 

116 

0.8% 

Reported Risk 

 

 

 

 

 

 

MSM 

17,706 

34% 

469 

2.6% 

308 

1.7% 

PWID 

3,164 

6% 

19 

0.6% 

0.3% 

MSM/PWID 

655 

1% 

27 

4.1% 

14 

2.1% 

Adult Other 

29,277 

56% 

115 

0.4% 

58 

0.2% 

Unknown 

1,089 

2% 

0.6% 

0.3% 

Table 22a: Profiles of HIV testing programs funded by DSHS in 2018

 

Routine Testing Programs 

 

Tests 

All positive 
tests 

Only new 
diagnoses 

 

Number 

% of 
tests 

Number 

Positive 
rate 

Number 

Diagnosis 
rate 

Total 

227,860 

 

1,496 

0.7% 

293 

0.1% 

Sex 

 

 

 

 

 

 

Men 

99,825 

44% 

1,087 

1.1% 

217 

0.2% 

Women 

128,000 

56% 

407 

0.3% 

75 

0.1% 

Transgender women 

10 

0% 

20.0% 

10.0% 

Transgender men 

 

 

 

 

 

 

Unknown 

25 

0% 

0% 

0% 

Race/Ethnicity 

 

 

 

 

 

 

White 

55,205 

24% 

288 

0.5% 

65 

0.1% 

Black 

63,594 

28% 

837 

1.3% 

132 

0.2% 

Hispanic 

91,173 

40% 

268 

0.3% 

83 

0.1% 

Other 

17,994 

8% 

90 

0.5% 

12 

0.1% 

Multi-race 

17 

0% 

13 

76.5% 

5.9% 

Age group (years) 

 

 

 

 

 

 

0-14 

697 

0% 

0.1% 

0% 

15-24 

37,475 

16% 

132 

0.4% 

47 

0.1% 

25-34 

46,242 

20% 

430 

0.9% 

88 

0.2% 

35-44 

44,045 

19% 

353 

0.8% 

63 

0.1% 

45-54 

40,838 

18% 

306 

0.7% 

51 

0.1% 

55-64 

36,739 

16% 

228 

0.6% 

41 

0.1% 

65+ 

21,820 

10% 

43 

0.2% 

0.0% 

Unknown 

127 

0% 

2.4% 

0% 

Geography 

 

 

 

 

 

 

Austin TGA 

40,961 

18% 

126 

0.3% 

24 

0.1% 

Dallas EMA 

60,133 

26% 

431 

0.7% 

156 

0.3% 

Fort Worth TGA 

66,884 

29% 

492 

0.7% 

43 

0.1% 

Houston EMA 

31,117 

14% 

315 

1.0% 

41 

0.1% 

San Antonio TGA 

 

 

 

 

 

 

Rest of Texas 

28,888 

13% 

132 

0.5% 

29 

0.1% 

Reported Risk 

 

 

 

 

 

 

MSM 

 

 

46 

  

17 

  

PWID 

 

 

  

 

MSM/PWID 

 

 

  

 

Adult Other 

 

 

196 

 

30 

 

Unknown 

 

  

1,247 

 

245