Missed Opportunities for HIV Prevention: Individuals Who HIV Seroconverted Despite Accessing Healthcare

Francesca Cossarini, David B. Hanna, Mindy S. Ginsberg, Oni J. Blackstock, Kathryn Anastos, Uriel R. Felsen

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Individuals with a negative HIV test before a positive one (seroconverters) may represent missed opportunities for prevention. To inform HIV prevention strategies, we aimed to characterize patients who seroconverted despite accessing care. We identified patients at a large, urban healthcare system who seroconverted between 2009 and 2014. Demographics, visits, and HIV-related variables were extracted from the medical records. We performed descriptive statistics, assessed for trends, and tested for associations according to sex. 220 seroconverters were identified: 45% were female, 87% were non-Hispanic Black or Hispanic, and median number of negative tests prior to diagnosis was 2 (IQR 1–3). Overall, 49% reported heterosexual contact as their risk factor and the proportion with heterosexual risk increased over time (24% in 2009 vs. 56% in 2014, p = 0.03). Compared to men, women were older at the time of diagnosis (35 vs. 26 years old, p < 0.01), had more visits between their latest negative and positive HIV test (4 vs. 2, p < 0.01), and were more likely to be diagnosed in the context of screening (64% vs. 56%, p = 0.05). We identified a population that became HIV-infected despite multiple healthcare encounters and undergoing HIV testing multiple times. Patients were mostly heterosexual and almost half were female. To avoid missed opportunities for those already accessing care, HIV prevention efforts should include strategies tailored to individuals with less frequently recognized risk profiles.

Original languageEnglish (US)
Pages (from-to)3519-3524
Number of pages6
JournalAIDS and Behavior
Issue number11
StatePublished - Nov 1 2018


  • Epidemiology
  • HIV prevention
  • Missed opportunities
  • Seroconverters

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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