More HIV testing will be available in the Chicago area, thanks to a five-year, $4.5 million federal public health grant recently awarded to the University of Chicago Medicine.
The grant, for the hospital's Expanded HIV Testing and Linkage to Care (xTLC) program, will allow the hospital to increase the number of HIV tests it administers on the South and West sides of Chicago, and for the first time, offer testing in suburban Cook County.
The program will be expanded into UChicago Medicine Ingalls Memorial Hospital in Harvey, Loyola University Medical Center in Maywood, and Howard Brown Health Center, an LGBTQ organization with sites throughout Chicago. There are now 16 institutions partnering with UChicago Medicine on this initiative.
"It's all part of the bigger effort toward HIV elimination," said David Pitrak, MD, chief of infectious diseases and global health, who heads up the xTLC program and is also co-director of the Chicago Center for HIV Elimination (CCHE).
Even though HIV has leveled off since 2012 from its peak in the 1980s, Pitrak estimates one out of every 100 people in Chicago now lives with HIV.
Roughly 1.2 million people in the United States have the HIV virus, according to the Centers for Disease Control and Prevention. About 14% of them (1 in 7, or about 240,000 people) are unaware they are infected.
HIV stands for human immunodeficiency virus. The virus weakens a person's immune system by destroying cells that fight disease and infection. HIV is treatable with prescription drugs, but if left untreated, it can be transmitted to others and will likely evolve into AIDS, a potentially deadly disease.
Pitrak said the number of HIV cases is going down in every demographic except one: young black men who have sex with men and women. He hopes that xTLC's additional testing will reach people in this at-risk demographic, to help them get treatment or preventative interventions, including pre-exposure prophylaxis (PrEP) medication.
Of the 474,221 tests conducted between 2011 and 2018, 2,451 were found to be HIV-positive, and 735 of those tested were unaware that they had the virus.
With the grant, xTLC plans to conduct more than 150,000 tests annually. The program administered 104,000 tests in 2018.
We're definitely a leading institution in this area. And we're the major provider of HIV care and preventative services on the South Side, which is a disproportionately affected area.
David Pitrak, MD, chief of infectious diseases and global health, UChicago Medicine
The hospital started administrating HIV blood tests in 2007, Pitrak said, but it didn't receive its first grant for expanded testing until 2011. That led to the creation of xTLC and expansion into the West Side communities, contributing to the decline of HIV cases in Chicago.
Meanwhile, laws changed so that blood tests done in emergency rooms or other medical offices automatically test for HIV unless a patient opts out. In the past, a doctor would have to ask permission from a patient to conduct the test.
People don't get tested for HIV for several reasons, Pitrak said. Either they think it'll be expensive, or they doubt they're infected. The virus is more prevalent among intravenous drug users, and men or women who have had sex with a man who's had male sex partners.
The HIV test is covered by insurance, including Medicaid. The cost of testing is not prohibitive, and even the uninsured can get tested – a cost the hospital will typically waive for community benefit, Pitrak said.
Getting diagnosed early is important because it stops transmission to other people. Also, 97% of untreated HIV cases end up becoming AIDS.
Pitrak said it's a team effort for xTLC to provide HIV tests at different locations, collect data, and coordinate follow-up care. Besides Pitrak, other key members of the team include: CCHE co-director John Schneider, MD; CCHE Director of Prevention Rebecca Eavou; Associate Director of HIV Care and Prevention Jess Schmitt; Senior Data Analyst Nora Friedman; Director of HIV testing Moira McNulty, MD; and social workers Michelle Taylor and Lindsey Wesley-Madgett, who have the challenging job of telling people they're HIV-positive and arranging follow-up care.
"You need to continue the whole public health effort to keep it under control," Pitrak said. "Everything we do is with the goal of getting to zero cases."