{
  "abstract": "Background In recent years, HIV diagnoses in Italy have increased, particularly in Lombardy and the metropolitan area of Milan. In this context, counselling and testing services at local sexually transmitted infection (STI) centres play a pivotal role in prevention and early diagnosis, especially among vulnerable populations. We aimed to describe the hub-and-spoke service network of the Infectious Diseases Department at Luigi Sacco Hospital, which integrates the low-threshold, free-access territorial STI Clinic Jenner 44 with specialized hospital-based facilities, and to analyze clinical and demographic characteristics of individuals diagnosed with HIV.Methods We conducted a retrospective observational study including adults ≥18 years who attended the Jenner 44 STI Clinic between 1 January 2024 and 31 August 2025 and had a confirmed positive HIV test during the study period (either newly diagnosed or previously diagnosed and re-engaged in care). Demographic, clinical, and laboratory data, as well as linkage-to-care pathways, were extracted from the center’s electronic database.Results A total of 63 individuals who tested positive for HIV were included. Among them, 35 (55.6%) were newly diagnosed with HIV, while 28 (44.4%) had a previously known diagnosis and attended for re-engagement in care. People with HIV were predominantly males (90.5%), with a median age of 33 years [IQR 28–39]. Majority were MSM (30, 47.6%), and 17.5% were transgender women ( table 1). The most represented ethnicity was Latin American (37/63, 58.7%), followed by Caucasian (19, 30.2%), African (5, 7.9%), and Asian (2, 3.2%). Only 42 individuals (66.7%) possessed a valid Italian healthcare card at the time of access. Most patients (53, 84.1%) accessed the STI clinic directly without referral. The most common reasons for testing were routine STI screening (10, 16%) and presence of clinical symptoms suggestive of HIV infection (13, 20.6%). Concomitant STI diagnoses were recorded in 42 subjects (66.7%): syphilis (33, 52.4%), Chlamydia trachomatis (3, 4.8%) and gonorrhoea (8,12.7%). Only one individual (1.6%) reported previous post-exposure prophylaxis (PEP), and none reported pre-exposure prophylaxis (PrEP) use prior to diagnosis. Among newly diagnosed individuals, the median HIV RNA viral load was 30,300 copies/mL (IQR 3,300–115,000), and the median CD4+ T-cell count was 457 cells/mm3 (IQR 270–692). Regarding retention in care 48 individuals, 76.2% were actively followed either at the territorial clinic or at the hospital Infectious Diseases Department, while 9 patients were lost to follow-up.Conclusions Our findings highlight the critical role of low-threshold STI services integrated within a hub-and-spoke model in identifying HIV infections and facilitating early linkage to care, particularly among vulnerable foreign-born populations. This integrated organizational strategy appears effective in reducing barriers to diagnosis although retention in care remains a challenge.Abstract SC3 Table 1Study population characteristics",
  "authors": [
    {
      "affiliations": [
        "SSD Fragilità e Prevenzione, STI Jenner 44 Clinic, Milan, Italy",
        "Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy"
      ],
      "name": "L Cordier"
    },
    {
      "affiliations": [
        "SSD Fragilità e Prevenzione, STI Jenner 44 Clinic, Milan, Italy",
        "Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy"
      ],
      "name": "M Morosi"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy"
      ],
      "name": "V Iannone"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy"
      ],
      "name": "L Oreni"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy"
      ],
      "name": "MV Cossu"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy",
        "Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy"
      ],
      "name": "A Giacomelli"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy"
      ],
      "name": "R Giorgi"
    },
    {
      "affiliations": [
        "Laboratory of Clinical Microbiology, Virology and Bioemergency Diagnostics, Luigi Sacco Hospital, Milan, Italy"
      ],
      "name": "V Micheli"
    },
    {
      "affiliations": [
        "Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy",
        "Laboratory of Clinical Microbiology, Virology and Bioemergency Diagnostics, Luigi Sacco Hospital, Milan, Italy"
      ],
      "name": "A Dolci"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy",
        "Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy"
      ],
      "name": "A Gori"
    },
    {
      "affiliations": [
        "SSD Fragilità e Prevenzione, STI Jenner 44 Clinic, Milan, Italy",
        "Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy"
      ],
      "name": "A Capetti"
    }
  ],
  "title": "SC3 Services and clinical pathways for HIV diagnosis for vulnerable populations: insights from a large HIV clinical center with hub-and-spoke network",
  "uid": "b19761c9-da11-5a3d-b116-cbf41aa6417f"
}