Abstract
BackgroundThe Centers for Disease Control and Prevention (CDC) estimates that 156,300 (95% CI 144,100–165,900) Americans living with HIV in 2012 were unaware of their infection. To increase knowledge of HIV status, CDC guidelines seek to make HIV screening a routine part of medical care. This paper examines how routinely California primary care providers test for HIV and how providers’ knowledge of California’s streamlined testing requirements, use of sexual histories, and having an electronic medical record prompt for HIV testing, relate to test offers.MethodsWe surveyed all ten California health plans offered under health reform’s Insurance Exchange (response rate = 50%) and 322 primary care providers to those plans (response rate = 19%) to assess use of HIV screening and risk assessments.ResultsOnly 31.7% of 60 responding providers reported offering HIV tests to all or most new enrollees and only 8.8% offered an HIV test of blood samples all or most of the time despite the California law requiring that providers offer HIV testing of blood samples in primary care settings. Twenty-eight of the 60 providers (46.6%) were unaware that California had reduced barriers to HIV screening by eliminating the requirement for written informed consent and pre-test counseling. HIV screening of new enrollees all or most of the time was reported by 53.1% of the well-informed providers, but only 7.1% of the less informed providers, a difference of 46 percentage points (95% CI: 21.0%—66.5%). Providers who routinely obtained sexual histories were 29 percentage points (95% CI: 0.2%—54.9%) more likely to screen for HIV all or most of the time than those who did not ask sexual histories.ConclusionChanging HIV screening requirements is important, but not sufficient to make HIV testing a routine part of medical care. Provider education to increase knowledge about the changed HIV testing requirements could positively impact testing rates.
Highlights
The National HIV/AIDS Strategy for the United States set three primary goals: reducing HIV incidence; increasing access to care for people living with HIV (PLWH) and reducing HIVrelated health disparities. [1] Providing preventive services for people at high risk for HIV and diagnosing PLWH who are unaware of their HIV infection are key to achieving these goals.Cost-benefit analyses demonstrate the benefits of routine HIV testing for adults. [2] Early detection and treatment of HIV infection improves the long-term health of people living with HIV (PLWH), and helps to prevent viral transmission to others
Changing HIV screening requirements is important, but not sufficient to make HIV testing a routine part of medical care
Despite the fact that the ACA has lowered the financial barriers for HIV screening and that California legislation has reduced many of the implementation barriers to routine HIV testing in medical settings only 31.7% of 60 providers who responded to our survey reported offering HIV tests to all or most new enrollees
Summary
The National HIV/AIDS Strategy for the United States set three primary goals: reducing HIV incidence; increasing access to care for people living with HIV (PLWH) and reducing HIVrelated health disparities. [1] Providing preventive services for people at high risk for HIV and diagnosing PLWH who are unaware of their HIV infection are key to achieving these goals.Cost-benefit analyses demonstrate the benefits of routine HIV testing for adults. [2] Early detection and treatment of HIV infection improves the long-term health of people living with HIV (PLWH), and helps to prevent viral transmission to others. The benefits of screening for HIV during routine medical visits were endorsed by the Centers for Disease Control and Prevention (CDC), which released a set of guidelines in 2006 that proposed every patient be screened at least once for HIV and that persons at high risk of HIV infection should be screened at least once a year. In 2007, the state passed a law that eliminated the requirement for written consent for an HIV test when ordered by a medical care provider. This paper examines how routinely California primary care providers test for HIV and how providers’ knowledge of California’s streamlined testing requirements, use of sexual histories, and having an electronic medical record prompt for HIV testing, relate to test offers
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