Background:  Washington, DC has among the highest rates of HIV/AIDS in the US with an estimated seroprevalence of 3% of the population. In 2006, the DC Department of Health launched an initiative to promote the implementation of routine HIV testing with improved linkage to care throughout the city in support of the revised US Centers for Disease Control (CDC) testing guidelines. Emphasis was placed on encouraging routine testing in medical settings and increasing testing and linkage to medical care for newly identified infected individuals.

Methods:  Trends in the number of tests performed by Department of Health (DOH) publicly supported sites were reviewed. In this ecologic analysis, HIV/AIDS name-based surveillance data from 2004 to 2008 were analyzed to assess clinical indicators at the time of HIV diagnosis, with a report of CD4 count, percentage or a viral load used as a measure of entry into care. The proportion of late testers, defined as those persons diagnosed with AIDS whose HIV diagnosis occurred within 12 months of their AIDS diagnosis, was calculated.

Results:  In 2004, 2006 (the start of routine testing expansion) and 2008, the District performed approximately 19,000, 35,000, and 73,000 HIV tests, respectively, at publicly-funded sites. The number of new diagnoses of HIV/AIDS name-based cases reported between 2004 and 2007 increased 17% from 1,093 cases to 1,280 cases; data from 2008 are still preliminary, but include 1,037 reports to date. Sixty-two percent of cases had a first CD4 count, percentage or viral load reported within 3 months of HIV diagnosis in 2004 compared with 67% in 2008 (Chi-square for trend, p-value <0.001). The median CD4 count among newly diagnosed cases increased 57% from 216 cells/mL in 2004 to 340 cells/mL in 2008 (Chi-square for trend, P <0.001). Among newly diagnosed AIDS cases, the proportion of late testers decreased from 66% in 2004 to 57% in 2008 (Chi-square for trend, P =0.0018).

Conclusions:  Expanded routine HIV testing in Washington DC has been associated with increased identification of HIV/AIDS cases, more rapid entry into care as measured by time to initial CD4 count, percent or viral load, and earlier diagnosis as indicated by the initial CD4 count itself and the decreasing proportion of late testers among AIDS cases. Continued surveillance will help determine whether these findings will translate into improved clinical outcomes and reduced HIV transmission.