METHODS: In-migrant PLWH between 2010 and 2014 were obtained from the Enhanced HIV/AIDS Reporting System (eHARS). Syphilis testing, investigation, and diagnosis information was obtained from the WA STD surveillance system syphilis registry and matched to eHARS. Date of entry into WA was defined as the collection date of the first HIV lab test in WA or date reported to WA eHARS, whichever earlier. WA syphilis lab test dates 30 days prior to or 90 days after in-migration were considered to be “time of WA in-migration.” We calculated the proportion of in-migrant PLWH who were tested, investigated for, or diagnosed with syphilis at entry, as well as proportion diagnosed with syphilis before and after in-migration.
RESULTS: In-migrating PLWH increased 36.7% from 2010 (n=335) to 2014 (n= 458). Approximately 8% (n=148) of PLWH were diagnosed with early syphilis at least once before moving into WA. This proportion remained constant over the 5 year period. Upon in-migration, the proportion of PLWH with a syphilis investigation significantly increased from 4.5% in 2010 compared to 8.7% in 2014 (p=0.02). However, the proportion of investigations resulting in actual new early diagnoses did not increase (12.5% on average, 2010-2014). The proportion of in-migrant PLWH tested for syphilis at time of entry significantly increased from 2010 (7.6%) compared to 2014 (17.3%). The proportion of PLWH diagnosed with early syphilis after entry significantly decreased from 7.8% in 2010 to 2.4% in 2014 (p=0.0008).
CONCLUSIONS: We found with the increasing number of in-migrating PLWH, the proportion of PLWH diagnosed with early syphilis at time of entry remained steady and the proportion diagnosed with syphilis after entry significantly decreased. The significant increase in PLWH tested for syphilis at entry could explain the significant increase in syphilis investigations at time of entry. Further investigation is needed to determine if the link between syphilis and HIV in WA is as strong as once thought.