Abstract
In 2006, CDC recommended HIV screening as part of routine medical care for all persons aged 13–64 years. We examined adherence to the recommendations among a sample of HIV care providers in the US to determine if known providers of HIV care are offering routine HIV testing in outpatient settings.Data were from the CDC's Medical Monitoring Project Provider Survey, administered to physicians, nurse practitioners and physician assistants from June-September 2009. We assessed bivariate associations between testing behaviors and provider and practice characteristics and used multivariate regression to determine factors associated with offering HIV screening to all patients aged 13–64 years.Sixty percent of providers reported offering HIV screening to all patients 13 to 64 years of age. Being a nurse practitioner (aOR = 5.6, 95% CI = 2.6–11.9) compared to physician, age<39 (aOR = 1.9, 95% CI = 1.0–3.5) or 39–49 (aOR = 2.1, 95% CI = 1.4–3.3) compared with ≥50 years, and black race (aOR = 2.6, 95% CI = 1.2–6.0) compared with white race was associated with offering testing to all patients. Providers with low (aOR = 0.2, 95% CI = 0.1–0.3) or medium (aOR = 0.4, 95% CI = 0.2–0.6) HIV-infected patient loads were less likely to offer HIV testing to all patients compared with providers with high patient loads.Many providers of HIV care are still conducting risk-based rather than routine testing. We found that provider profession, age, race, and HIV-infected patient load were associated with offering HIV testing. Health care providers should use patient encounters as an opportunity to offer routine HIV testing to patients as outlined in CDC's revised recommendations for HIV testing in health care settings.
Highlights
The public health importance of identifying HIV-infected persons and linking them to care and treatment is three-fold: 1) providing care and antiretroviral therapy (ART) can improve the health outcomes of HIV-positive persons [1,2]; 2) initiating ART may decrease transmission of HIV through the suppression of viral load [3]; and 3) awareness of one’s positive HIV status often results in reductions in high-risk behavior that may transmit HIV [4,5]
In 2001, CDC issued recommendations for routine HIV testing in clinical settings and of pregnant women [11] resulting in increased testing rates and identification of positives [12,13,14] and decreased effectiveness of targeted testing based on risk factors [15,16]
Factors significantly associated with offering HIV screening to all patients aged 13–64 years (p,.10) were included in multivariate regression models using backwards stepwise regression, and adjusted odds ratios and corresponding 95% confidence intervals (CIs) were computed
Summary
The public health importance of identifying HIV-infected persons and linking them to care and treatment is three-fold: 1) providing care and antiretroviral therapy (ART) can improve the health outcomes of HIV-positive persons [1,2]; 2) initiating ART may decrease transmission of HIV through the suppression of viral load [3]; and 3) awareness of one’s positive HIV status often results in reductions in high-risk behavior that may transmit HIV [4,5]. Implementation of routine HIV testing by health care providers presents an opportunity for diagnosis of HIV early in the course of disease. In 2001, CDC issued recommendations for routine HIV testing in clinical settings and of pregnant women [11] resulting in increased testing rates and identification of positives [12,13,14] and decreased effectiveness of targeted testing based on risk factors [15,16]. In 2006, CDC recommended HIV screening as part of routine medical care for all persons aged 13–64 years to decrease the number of people with undiagnosed HIV, diagnose HIV-infected persons at earlier stages of infection, link newly infected persons into care at earlier stages of infection, and prevent new infections [17]
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