Receipt of HIV and STD Testing Services During Routine General Medical or Gynecological Examinations: Variations by Patient Sexual Risk Behaviors

Abstract

Clinical practice guidelines in the United States recommend screening patients who report high-risk sexual behaviors (HRSB) for human immunodeficiency virus (HIV) and selected sexually transmitted diseases (STDs). The objective of this study was to estimate HIV and STD diagnostic and testing practices during routine general medical examinations (RGME) or gynecological examinations (GYNE) of patients by their reported HRSB status. We analyzed medical claims data from commercially-insured patients in the United States who sought care during 2000-2003. International Classification of Disease-9 (ICD-9) diagnostic and Current Procedural Terminology procedural codes were used to identify claims for HRSB, RGME or GYNE, HIV and STD diagnoses, and HIV and STD tests. Of 4296 patients aged 15 to 54 years during RGME or GYNE, almost none had ICD-9 codes for HIV, syphilis, Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (NG) infection. Patients with claims for HRSB were significantly more likely than patients without a claim for HRSB to be tested for HIV, syphilis, CT, and NG. Among patients with HRSB-RGME, men were significantly more likely to be tested for HIV (79.3% vs. 38.8%) and syphilis (39.1% vs. 27.6%) and less likely to be tested for CT (20.7% vs. 56.9%) and NG (20.7% vs. 50.9%) than were women. A large proportion of patients with HRSB at RGME or GYNE did not receive HIV and STD tests. Interventions to increase HIV and STD testing of patients at visits with claims for HRSB are needed to enhance guideline adherence.