The Centers for Disease Control and Prevention now recommends routine (non-targeted) HIV testing in all health care settings, including hospital emergency departments (EDs) and urgent care clinics (UCCs). HIV diagnoses from acute care settings represent a key target population for treatment and prevention efforts, especially since medical HIV testing initiatives often serve vulnerable urban groups who have been shown to be at increased risk for failing to engage in care. However, an estimated 30-50% of new HIV diagnoses in the U.S. fail to enter care within 6 months. Few studies exist on how to rapidly and fully engage recently diagnosed HIV patients in care. Moreover, little is known about how being diagnosed via routine (non-targeted) testing impacts retention in the first months of care. The goals of this proposal are to generate knowledge about the determinants of rapid and full engagement in HIV care and develop strategies to promote it. This research is guided by a conceptual- theoretical model that informs measurement instruments and a structured research plan. For patients diagnosed with HIV via routine (non-targeted) testing in the San Francisco General Hospital ED/UCC and who establish care in the SFGH HIV clinic, specific aims are to: 1) Identify barriers to and facilitators of rapid full engagement in care;2) Determine predictors of rapid full engagement in HIV care;3) Develop an intervention to promote rapid full engagement in HIV care.
Specific Aim 1 will be accomplished via qualitative methods.
Specific Aim 2 will be accomplished through baseline assessment of socio-demographic, behavioral, and clinical variables and use of the electronic medical record to track appointment and clinical outcomes.
Specific Aim 3 will be accomplished through analysis of data from Aims 1 &2, a literature review of related fields, and stakeholder input. Through a focused program of coursework and mentored training, the candidate will develop the skills in qualitative inquiry, cohort-based epidemiologic approaches, behavioral theory and intervention development to execute these specific aims and lay the foundation to become an independent investigator dedicated to closing the gap between HIV case identification and care initiation.

Public Health Relevance

HIV screening in the U.S. has expanded to acute medical settings, such as emergency departments and urgent care clinics, where patients are offered testing regardless of the reason for the visit. Little is known about how patients newly diagnosed with HIV in acute medical settings establish outpatient HIV care. This research will help identify key factors in rapid and full engagement in HIV care and develop an intervention to support this process.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
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Stirratt, Michael J
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Christopoulos, Katerina A; Scheer, Susan; Steward, Wayne T et al. (2015) Examining clinic-based and public health approaches to ascertainment of HIV care status. J Acquir Immune Defic Syndr 69 Suppl 1:S56-62
Christopoulos, Katerina A; Olender, Susan; Lopez, Andrea M et al. (2015) Retained in HIV Care But Not on Antiretroviral Treatment: A Qualitative Patient-Provider Dyadic Study. PLoS Med 12:e1001863
Christopoulos, Katerina A; Riley, Elise D; Tulsky, Jacqueline et al. (2014) A text messaging intervention to improve retention in care and virologic suppression in a U.S. urban safety-net HIV clinic: study protocol for the Connect4Care (C4C) randomized controlled trial. BMC Infect Dis 14:718
Das, Moupali; Christopoulos, Katerina A; Geckeler, Dara et al. (2013) Linkage to HIV care in San Francisco: implications of measure selection. J Acquir Immune Defic Syndr 64 Suppl 1:S27-32
Christopoulos, Katerina A; Massey, Amina D; Lopez, Andrea M et al. (2013) Patient perspectives on the experience of being newly diagnosed with HIV in the emergency department/urgent care clinic of a public hospital. PLoS One 8:e74199
Christopoulos, Katerina A; Zetola, Nicola M; Klausner, Jeffrey D et al. (2013) Leveraging a rapid, round-the-clock HIV testing system to screen for acute HIV infection in a large urban public medical center. J Acquir Immune Defic Syndr 62:e30-8
Christopoulos, Katerina A; Havlir, Diane V (2013) Overcoming the human immunodeficiency virus obstacle course. JAMA Intern Med 173:1344-5
Christopoulos, Katerina A; Massey, Amina D; Lopez, Andrea M et al. (2013) ""Taking a half day at a time:"" patient perspectives and the HIV engagement in care continuum. AIDS Patient Care STDS 27:223-30
Geng, Elvin H; Hare, C Bradley; Kahn, James O et al. (2012) The effect of a ""universal antiretroviral therapy"" recommendation on HIV RNA levels among HIV-infected patients entering care with a CD4 count greater than 500/?L in a public health setting. Clin Infect Dis 55:1690-7
Arnold, Emily A; Hazelton, Patrick; Lane, Tim et al. (2012) A qualitative study of provider thoughts on implementing pre-exposure prophylaxis (PrEP) in clinical settings to prevent HIV infection. PLoS One 7:e40603

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