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Epi Profile Section 8 – HIV Testing in Programs Funded by the Department of State Health Services

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 primarily carried out in hospital emergency departments in areas with higher numbers of people living with HIV. A relatively 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

Demographics

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%

5

1.4%

Transgender men

11

0%

0

0.0%

0

0.0%

Unknown

61

0%

0

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%

6

1.3%

3

0.7%

Age group (years)

           

0-14

62

0%

1

1.6%

0

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%

8

0.3%

65+

851

2%

7

0.8%

2

0.2%

Unknown

51

0%

0

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%

8

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%

7

0.6%

3

0.3%


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

 

Routine Testing Programs

 

Tests

All positive
tests

Only new
diagnoses

Demographics

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%

2

20.0%

1

10.0%

Transgender men

 

 

 

 

 

 

Unknown

25

0%

0

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%

1

5.9%

Age group (years)

           

0-14

697

0%

1

0.1%

0

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%

3

0.0%

Unknown

127

0%

3

2.4%

0

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

 

 

6

 

1

 

MSM/PWID

 

 

1

 

0

 

Adult Other

 

 

196

 

30

 

Unknown

 

 

1,247

 

245

 

 

Texas HIV Epidemiologic Profile