Monitoring HIV Testing at Visits to Emergency Departments in the United States: Very-Low Rate of HIV Testing
ABSTRACT BACKGROUND:: Early diagnosis and treatment of HIV infection results in improved clinical outcomes and decreased transmission, yet many infected persons are unaware of their infection or diagnosed late. The Centers for Disease Control and Prevention (CDC) recommends routine opt-out testing of all persons aged 13-64 in high prevalence settings. STUDY OBJECTIVE:: To describe methods to estimate HIV testing rates at visits to emergency departments (EDs) for monitoring adherence to recommendations for opt-out testing. METHODS:: We analyzed data from the 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS). In 2009, two questions were added to the survey about HIV status and testing. We estimated the frequency of HIV testing at ED visits made by persons aged 13-64 years not known to be HIV infected. RESULTS:: In 2009, 90.5 million visits were made to EDs, including 60.0% by whites, 24.5% by blacks, and 12.1% by Hispanics; and 38.4% by privately insured, 25.7% by Medicaid insured, and 21.4% by uninsured persons. Among 89.9 million visits by patients not known to be HIV infected, HIV testing was performed at only 0.2% of visits. Among 3.4 million visits made by persons in whom targeted testing is recommended-those with increased risk for HIV and other sexually transmitted diseases, or pregnancy-only 2.3% were tested for HIV. CONCLUSIONS:: NHAMCS can be a useful tool to monitor trends in HIV testing in U.S. emergency departments. A high proportion of visits to EDs in the United States were made by persons in historically medically underserved populations and routine HIV testing was a rare event during ED visits.
- SourceAvailable from: onlinelibrary.wiley.com[Show abstract] [Hide abstract]
ABSTRACT: Over the last thirty years, the human immunodeficiency virus (HIV) epidemic has matured. In the United States, HIV has changed from an explosive outbreak to an endemic disease; currently, an estimated 1.1 million people are infected with HIV, including a substantial number who are unaware of their status. With recent findings demonstrating the high transmissibility of HIV early in infection, and the potential benefit of early initiation of treatment, it is essential to identify as many infected individuals as possible. The Centers for Disease Control and Prevention (CDC) has expanded HIV testing to include any healthcare setting, including dental offices. Testing advances, including oral testing, have reduced the window period of HIV infection. Dental care represents a key, reliable, independent, and confidential link between the healthcare system and the general population that has been under-utilized in the effort to control the HIV epidemic. HIV testing is straightforward, and knowledge of the types of testing will afford dentists an important opportunity to help advance and preserve the health of their patients and to promote the public health of their community. Here, we review the basics of HIV testing and discuss new changes in the approach to HIV diagnostics.Oral Diseases 11/2012; DOI:10.1111/odi.12047 · 2.40 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Routine screening is recommended for HIV detection. HIV risk estimation remains important. Our goal was to validate the Denver HIV Risk Score (DHRS) using a national cohort from the CDC. Patients ≥13 years of age were included, 4,830,941 HIV tests were performed, and 0.6% newly-diagnosed infections were identified. Of all visits, 9% were very low risk (HIV prevalence = 0.20%); 27% low risk (HIV prevalence = 0.17%); 41% moderate risk (HIV prevalence = 0.39%); 17% high risk (HIV prevalence = 1.19%); and 6% very high risk (HIV prevalence = 3.57%). The DHRS accurately categorized patients into different HIV risk groups.JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2015; DOI:10.1097/QAI.0000000000000518 · 4.39 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The New York State HIV testing law requires that patients aged 13-64 years be offered HIV testing in health care settings. We investigated the extent to which HIV testing was offered and accepted during the 24 months after law enactment. We added local questions to the Behavioral Risk Factor Surveillance System (BRFSS) and the National HIV Behavioral Surveillance (NHBS) surveys asking respondents aged 18-64 years whether they were offered an HIV test in health care settings, and whether they had accepted testing. Statewide prevalence estimates of test offers and acceptance were obtained from a combined 2011-2012 BRFSS sample (N = 6,223). Local estimates for 2 high-risk populations were obtained from NHBS 2011 men who have sex with men (N = 329) and 2012 injection drug users (N = 188) samples. BRFSS data showed that 73% of New Yorkers received care in any health care setting in the past 12 months, of whom 25% were offered an HIV test. Sixty percent accepted the test when offered. The levels of test offer increased from 20% to 29% over time, whereas acceptance levels decreased from 68% to 53%. NHBS data showed that 81% of men who have sex with men received care, of whom 43% were offered an HIV test. Eighty-eight percent accepted the test when offered. Eighty-five percent of injection drug users received care, of whom 63% were offered an HIV test, and 63% accepted the test when offered. We found evidence of partial and increasing implementation of the HIV testing law. Importantly, these studies demonstrated New Yorkers' willingness to accept an offered HIV test as part of routine care in health care settings.