Towards ending the human immunodeficiency virus epidemic in the US: State of human immunodeficiency virus screening during physician and emergency department visits, 2009 to 2014.

Abstract

Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations.We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4.HIV testing rates in physician offices increased by 105% (5.6–11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3–6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37–11.85]), males (OR 1.34, [CI: 0.91–0.93]), African-Americans (OR 2.97, [CI: 2.05–4.31]), Hispanics (OR 1.80, [CI: 1.17–2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23–3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50–4.73), Hispanics (OR 2.23, 99% CI 1.65–3.01), and Northeast (OR 2.24, 99% CI 1.10–4.54).While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended.