Routine HIV Testing among Providers of HIV Care in the
United States, 2009
A. D. McNaghten1*, Eduardo E. Valverde1, Janet M. Blair1, Christopher H. Johnson1, Mark S. Freedman1,
Patrick S. Sullivan2
1Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, 2Rollins School of Public Health, Emory University, Atlanta, Georgia, United
States of America
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.
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.
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
Sixty percent of providers
Many providers of HIV
Citation: McNaghten AD, Valverde EE, Blair JM, Johnson CH, Freedman MS, et al. (2013) Routine HIV Testing among Providers of HIV Care in the United States,
2009. PLoS ONE 8(1): e51231. doi:10.1371/journal.pone.0051231
Editor: Sten H. Vermund, Vanderbilt University, United States of America
Received September 6, 2012; Accepted October 31, 2012; Published January 14, 2013
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for
any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding: This project was funded exclusively by the Centers for Disease Control and Prevention, which conceived the project, developed project-associated
materials including data collection instruments, provided oversight of implementation, conducted analytic procedures, and developed this report.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: firstname.lastname@example.org
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 ; and 3) awareness of one’s positive HIV status often results
in reductions in high-risk behavior that may transmit HIV [4,5].
However, HIV is still diagnosed late in the course of disease for
many people in the US: in 2008, 32% of persons with an HIV
diagnosis received a diagnosis of AIDS within 12 months of their
initial HIV diagnosis . Implementation of routine HIV testing
by health care providers presents an opportunity for diagnosis of
HIV early in the course of disease.
Recommendations regarding who should be tested for HIV
have evolved since HIV testing first became available in 1985.
Early testing guidelines recommended testing for persons engaging
in high-risk behaviors and those considered likely to be infected
. Later recommendations expanded to clinical settings including
hospitals and emergency departments, particularly in higher
prevalence areas , and pregnant women [9,10]. Modifications
to recommendations decreased barriers to the testing process,
making the consent process easier and increasing access to testing
in a variety of clinical settings. In 2001, CDC issued recommen-
dations for routine HIV testing in clinical settings and of pregnant
women  resulting in increased testing rates and identification
of positives [12–14] and decreased effectiveness of targeted testing
based on risk factors [15,16]. Changes over time in populations
affected by HIV provided strong rationale for the implementation
of routine HIV testing in all health care settings. 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 .
The revised recommendations are for routine, opt-out screening
for HIV for persons aged 13 to 64 in health care settings, including
emergency departments . As part of patients’ general informed
consent, similar to other diagnostic and screening or routine
prenatal tests, oral or written information should be provided to
notify patients that they will be tested unless they decline.
Prevention counseling is no longer a part of routine HIV testing,
but still is recommended for persons known to engage in behaviors
that place them at risk for acquiring HIV. The guidelines
recommend annual testing of persons considered to be at high
PLOS ONE | www.plosone.org1 January 2013 | Volume 8 | Issue 1 | e51231
risk for acquiring HIV, and state that diagnostic testing should be
performed for patients with HIV-related signs or symptoms .
Although these guidelines have been in place since September
2006, minimal data have been presented on the adoption of
routine testing by health care providers, particularly in outpatient
settings where routine health care is delivered. We examined self-
reported adherence to the CDC 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
Materials and Methods
Data Source and Sampling
Data were collected as part of the CDC’s Medical Monitoring
Project (MMP) Provider Survey, a survey administered to a
nationally representative sample of HIV care providers who were
selected to participate in MMP. MMP is an ongoing, supplemental
surveillance system conducted in 20 states and six cities/counties
that collects clinical and behavioral data on HIV-infected persons
$18 years receiving care in the U.S. The methods of MMP have
been previously described [18–20]. Briefly, MMP involves a three-
stage sampling design. In the first stage, 20 states, which included
.80% of the AIDS prevalence in the US (as of 2002), were
sampled using probability proportional to size (PPS) sampling.
Health departments in these 20 states and in six cities/counties
within those states that are funded and administered separately for
HIV/AIDS surveillance activities were funded to participate in
MMP, resulting in 26 project areas. In the second stage, health
department staff developed a facility sampling frame for their
individual project areas. Facilities were eligible to be included on
the frame if they were known to provide outpatient HIV care
(defined as prescribing antiretroviral therapy or ordering CD4 or
HIV viral load tests) to patients $18 years of age and managed
their HIV-infected patients’ medical care rather than referring
them to other providers. A sample of facilities was selected from
this facility sampling frame using PPS sampling. In the third stage,
a sample of patients who received care at the sampled facilities
during a specified time period was selected using a method that
resulted in an equal probability of selection at the patient level.
The Provider Survey was administered to providers from the
sampled facilities. Providers’ contact information from participat-
ing sampled facilities was obtained by health department staff and
each provider was assigned a unique MMP Provider Survey
identification number. Based on available funding, a sub-sample of
2,000 providers was randomly selected from an estimated 2,550
individual providers participating in the MMP 2007 data
Health care providers eligible for the survey included physi-
cians, nurse practitioners and physician assistants. Interns,
residents and fellows in training programs were not included. Of
the 2,000 health care providers sampled, 1,718 were eligible.
The MMP Provider Survey was conducted from June through
September 2009. Using the identification numbers, personalized
recruitment packets containing a recruitment letter describing the
purpose of the survey, information on how to access the survey
online, a paper copy of the survey with a postage-paid return
envelope, and a $15 gift card were sent to the sampled providers.
The Total Design Method [21,22] was used to increase response
to the survey. Reminder postcards were sent to all sampled
providers one week after the initial mailing, and a replacement
survey, a copy of the original recruitment letter, and a letter for
non-responders were sent to all providers who had not completed
the survey at three and seven weeks following the initial mailing.
The survey included questions about provider demographics,
length of time in practice, self-assessed knowledge about HIV,
practice characteristics, and offering HIV testing to patients.
Provider demographics included profession, board certification,
age, gender, race, ethnicity, length of time providing care for
patients with HIV/AIDS, whether they considered themselves to
be a specialist in the treatment of HIV/AIDS, and how
knowledgeable they considered themselves to be regarding HIV
treatment. Practice characteristics included how often they refer
their HIV patients to another provider with specialized knowledge
of HIV care and treatment and the number of patients with and
without HIV/AIDS to whom the provider gave care during an
average month. For the analysis, the number of HIV-infected
patients providers reported caring for per month was categorized
as low (1–19 patients), medium (20–74 patients) or high ($75
patients). Providers were asked to provide an estimate of the
percentage of their patients living with HIV/AIDS by race,
ethnicity, gender, and the percentage that injected drugs or were
men who had sex with other men. To assess adherence to CDC’s
recommendations for routine testing, the following question was
asked: ‘‘CDC recently recommended HIV screening in health care
settings for all patients 13 to 64 years of age. Do you offer HIV
screening to your patients?’’ The response options were: 1) Yes, to
all my patients 13 to 64 years of age; 2) Yes, but mainly to patients
who engage in high-risk behaviors; 3) No, but I plan to start
offering HIV screening for all my patients 13 to 64 years of age; 4)
No, I do not think HIV screening is necessary for all my patients
13 to 64 years of age; and 5) Not applicable, as I only see patients
living with HIV/AIDS. For the purpose of this analysis, response
options were dichotomized as 1) ‘‘Test All Patients’’, which
included only response 1 (‘‘Yes, to all my patients 13 to 64 years of
age’’), and 2) ‘‘Do Not Test All Patients’’, which included
responses 2 through 4 above.
CDC’s National Center for HIV, Viral Hepatitis, STD and TB
Prevention (NCHHSTP) has determined that MMP is a public
health surveillance, non-research activity used for disease control
program or policy purposes. Because NCHHSTP has determined
MMP is not research, it is not subject to human subjects
regulations including federal investigational review board (IRB).
As an amendment to MMP, the MMP Provider Survey is covered
under the same non-research determination. Participating project
areas obtain IRB approval as required in each jurisdiction to
Our analysis was restricted to providers whose practices
included HIV negative patients, as those with only HIV-infected
patients would not need to test. Chi-square analysis was used to
assess bivariate associations between testing behaviors and
provider and practice characteristics. Analysis of board certifica-
tion was limited to bivariate analysis since eligibility for
certification was dependent on provider type. 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
(aORs) and corresponding 95% confidence intervals (CIs) were
computed. Due to low patient-level response rates, analysis weights
were not derived for 2007 MMP data. Analyses were conducted
using SAS version 9.1 (SAS Institute, Cary, NC).
Routine Testing among HIV Providers
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Surveys were returned by 735 (42%) providers; 506 (69%) had
HIV-uninfected patients in their patient population and were
included in the analyses. Sixty percent reported offering HIV
screening to all patients 13 to 64 years of age. Thirty-one percent
reported offering screening mainly to those at high risk, and 9%
reported not offering HIV screening to patients. Table 1 presents
the characteristics of the providers by HIV testing behaviors.
When asked to describe characteristics of their HIV-infected
patient population, providers reported on average that 40% of
patients were black, 22% Hispanic, 34% white, 30% women, 18%
injection drug users (IDUs), and 59% were men who have sex with
men (MSM) (data not shown).
In bivariate analyses we found significant differences in
reporting offering HIV tests to all patients 13 to 64 years of age
by profession, infectious disease board certification, age, gender,
race/ethnicity, time providing care for HIV-infected patients,
whether providers considered themselves specialists in the
treatment of HIV/AIDS, providers’ self-reported knowledge of
HIV treatment, number of HIV-infected patients providers care
for, and percent of providers’ HIV-infected patients that were
white. With the exception of white race, differences in the
characteristics of providers’ HIV-infected patients, including race,
ethnicity, gender and risk behaviors, were not significant (Table 1).
In multivariate analysis, 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 age $50 years, and black race (aOR=2.6, 95%
CI=1.2–6.0) compared with white race was associated with
offering HIV testing to all patients. Providers having an HIV-
infected patient load per month that was low (aOR=0.2, 95%
CI=0.1–0.3) or medium (aOR=0.4, 95% CI=0.2–0.6) were less
likely to offer HIV testing to all patients according to the
recommendations compared with providers with high HIV-
infected patient loads (Table 2).
Sixty percent of HIV care providers who responded to the
MMP Provider Survey reported offering routine HIV screening to
all patients 13 to 64 years of age. Nurse practitioners, providers
aged ,50 years, black providers, and providers with high HIV-
infected patient loads were more likely to offer HIV testing to all
patients according to the recommendations. Although there is
limited information regarding the characteristics of providers who
conduct routine HIV testing, there is evidence that physicians who
had previously diagnosed an HIV-infected person were more likely
to offer HIV testing to their patients . Our data extend this
finding, by reporting that as the number of HIV-infected patients a
provider cares for increases, the likelihood of providing routine
No significant differences were found by characteristics of
providers’ HIV-infected patients. A higher percentage of providers
(65% versus 55%) reported offering testing to all patients if their
percent of white patients with HIV was less than 25% compared
with $25%, but this was not significant in the multivariate
analysis. However, others have found differences in routine
offering of HIV testing by age, race and ethnicity of patients.
Myers et al. found that blacks were more likely than whites to be
offered testing, and Latinos and persons of other racial/ethnic
groups (not Latino, white or black) were less likely to be offered
testing . The same study found that patients aged less than 55
years, and most notably men aged less than 18 years, were less
likely to be offered testing.
Since the release of the CDC recommendations, implementa-
tion and acceptance of routine HIV screening programs has been
successful in a variety of settings; most reports have been from
hospitals or emergency departments. In the first 8 months
following the October 2006 implementation of a hospital-wide
routine rapid HIV testing program at Howard University
Hospital, 57% of 9,810 patients who were offered testing agreed
to test . In a District of Columbia emergency department (ED)
where trained HIV screeners offered rapid testing to 4,187 patients
treated in the ED during a 3 month period, nearly 60% accepted
testing . Routine HIV screening was offered to 954 individuals
in three South Carolina community health clinics starting in
December 2006, with reported acceptance rates of 62%, 56% and
47%, respectively, in the first 8 months . Other attempts at
implementing routine testing have not been as successful. Routine
testing was offered to 3,467 patients in a District of Columbia
Veterans Affairs (VA) hospital from November 2007 through
March 2009, but only 25% accepted . Similarly, a Denver
emergency department offered routine opt-out testing to 28,043
patients from April 2007 through April 2008, with only 24%
accepting testing . In other facilities and health care systems,
routine HIV testing has yet to be implemented. A survey of
veterans conducted from mid-October 2008 through mid-Febru-
ary 2009 found that HIV testing is not being routinely offered by
VA providers. Of over 31,000 survey respondents, only 9% said
they had been offered an HIV test in the past 12 months .
Further, a 2009 online survey of MSM in the US found that only
about half of HIV-negative MSM reported being offered an HIV
test by their routine health care provider in the past year .
Although we did not ask providers their reasons for not
conducting routine HIV testing, several barriers to implementing
the recommendations have been documented  and are likely
similar to barriers experienced by our survey respondents. Barriers
identified include: state and federal agency laws [33–35];
providers’ concern about lack of prevention counseling [32,33];
stigma and discrimination associated with HIV [33,34]; and the
perception that conducting risk-based testing is more cost effective
than routine testing .
CDC acknowledged in the recommendations that state statutes
and clinic policies might pose barriers to fully implementing the
recommendations . These barriers were found by Mahajan
and colleagues when they examined whether implementing the
CDC recommendations was compatible with individual state
statutes during the two years following the release of the
recommendations . They reported that 16 states had statutes
that were inconsistent with the key features of the recommenda-
tions: 1) opt-out testing; 2) informed consent; and 3) lack of HIV
prevention counseling, meaning that implementing one or more of
the provisions of the recommendations could not occur without
amending existing laws. In the two years following the release of
the recommendations, nine of the 16 states passed laws that were
consistent ; in 2010, six states still had laws inconsistent with
the recommendations . Massachusetts, Michigan, Nebraska,
New York (with the exception of rapid testing) and Pennsylvania
still required specific written consent for HIV testing, and
Michigan, Pennsylvania and West Virginia still required post-test
counseling for a negative or positive result. In our survey provider
sample sizes were inadequate to assess state as a predictor to
determine the impact of state and clinic policies on implementing
Barriers to testing among physicians include pre-test counseling
requirements, lack of knowledge of testing recommendations and
requirements and lack of training in conducting HIV testing, lack
of time, lack of acceptance by patients, burden of the consent
Routine Testing among HIV Providers
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Table 1. Characteristics of HIV care providers by testing behaviors – United States, Medical Monitoring Project Provider Survey,
CharacteristicNumber (%) Test All Patients N (%)p-value
Total Providers506302 (60)
Physician401 (79)218 (54)
Nurse Practitioner68 (14)58 (85)
Physician Assistant37 (7)26(72)
Physician Infectious Disease Board
Yes 226 (59)112 (50)
No 160 (41)100 (63)
,39 78 (15)50 (64) 0.004
39–49 189 (38)125(67)
$50 234 (47)121(52)
Male 290 (58)152(52)
Female 214 (42)149 (70)
Black 43 (9)33 (77)0.006
Hispanic*49 (10)37 (75)
White 359 (71)201(56)
Other51 (10) 29 (57)
Time Caring for HIV+ Patients (years)
#5 65 (13)38 (59) 0.03
6–10 105 (21)74 (70)
.10 328 (66)183(56)
Specialist in HIV Treatment
Yes 378 (78)234(62) 0.03
No 109 (22) 55(50)
Knowledge in HIV Treatment
Extremely193 (38)127(66) 0.04
Very 223 (44) 131(59)
Somewhat83 (17) 40(48)
Not at all 6 (1)3 (50)
Number HIV+ Patients Provide Care to per
1–19 (low)116 (24)48 (41)
20–74 (medium) 206 (41)113(55)
$75 (high) 172 (35) 135(78)
Percent Black HIV+ Patients
,25% 177 (37)97 (55) 0.18
$25% 305 (63)186 (61)
Percent Hispanic HIV+ Patients
,25%337 (69) 195(58) 0.56
$25%145 (31)88 (61)
Percent White HIV+ Patients
,25%174 (37) 113(65)0.04
Percent Women HIV+ Patients
Routine Testing among HIV Providers
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process, language barriers, competing priorities and inadequate
compensation . Lack of training may be less of a barrier for
younger providers, who have likely received more training
regarding HIV testing, diagnosis and treatment than their older
counterparts. This is supported by our finding that younger
providers were more likely to offer testing. Lack of knowledge of
the recommendations was identified by a survey of internal
medicine residents in New York City conducted in early 2007
between five and nine months after the release of the recommen-
dations. Only 32% of those surveyed were aware of the
recommendations, and most were not offering routine testing;
36% of the residents used a routine testing approach, while 64%
reported utilizing risk-based testing . Sixty-eight percent said
they would order more HIV tests if consent were oral rather than
written and 46% had consent issues (written consent was required
by New York State law at the time), 41% reported lack of time,
and 20% cited language barriers. Factors associated with ordering
10 or fewer tests included lack of pre-test counseling training,
conducting risk-based testing, and taking sexual history never or
occasionally. In addition to the barriers above, lack of reimburse-
ment for the test and lack of capacity to provide services or
medications for patients with newly diagnosed HIV may also be
reasons that testing is not offered.
If recommendations for HIV screening are routinely imple-
mented, high percentages of patients offered testing would accept.
Although lack of patient acceptance was noted by physicians ,
the literature shows that when more patients are offered HIV
screening, more patients are tested. Six health centers that provide
primary care and prevention services to underserved populations
in North Carolina, South Carolina and Mississippi conducted
almost 3 times the number of HIV tests after implementing routine
testing compared with the previous year . Of the 9% of VA
patients mentioned above who said they had been offered an HIV
test in the past 12 months, 91% accepted . A survey to assess
patients’ acceptance of opt-out HIV testing in an urban emergency
department asked 529 patients if they would accept opt-out HIV
testing; 81% reported they would have accepted . In the VA
survey mentioned above, 73% of respondents reported they would
Table 1. Cont.
Characteristic Number (%)Test All Patients N (%)p-value
$25%271 (54)164 (60)
Percent IDU HIV+ Patients
,25% 364 (72)217(60)0.95
$25% 140 (28)83(59)
Percent MSM HIV+ Patients
,25%67 (13) 41(61) 0.79
$25%432 (87)257 (59)
*Hispanic persons may be of any race.
Table 2. Factors associated with HIV care providers offering HIV testing to all patients – United States, Medical Monitoring Project
Provider Survey, 2009.
Characteristic Adjusted Odds Ratio (95% Confidence Interval)p-value
Nurse Practitioner5.6 (2.6–11.9)
Physician Assistant1.7 (0.8–3.9) 0.23
,39 1.9 (1.0–3.5)0.03
39–49 2.1 (1.4–3.3)
Black 2.6 (1.2–6.0)0.02
Hispanic 2.0 (0.9–4.2)0.09
Other1.0 (0.5–2.0) 0.94
Average Number HIV+ Patients per Month
1–19 (Low)0.2 (0.1–0.3)
20–74 (Medium) 0.4 (0.2–0.6)
75 or more (High)Reference
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be ‘‘very likely’’ to accept HIV testing, if recommended by their
doctor , and focus groups at VA facilities found that both
patients and providers agreed that routine testing would be
beneficial to public health and to patients .
Although cost may be perceived to be a barrier to offering
routine testing, several recent studies have found routine opt-out
testing to be cost-effective [26,43–45]. Holtgrave found that risk-
based testing would result in more HIV diagnoses and prevent
more HIV infections at a lower cost compared with routine opt-
out testing, but in turn would increase the cost burden on the
health care system to provide medical care to these newly
identified persons .
Overall, HIV testing has increased in the US since the
guidelines were introduced, but awareness of the guidelines, the
importance of routine HIV testing, and current testing coverage
still needs to be conveyed to providers of HIV care and other
medical care providers in the US. The baseline for evaluating the
effects of CDC’s recommendations was developed from the
National Health Interview Survey (NHIS). This survey determined
that in 2006, an estimated 40.4% (71.5 million) of adults aged 18–
64 years in the US reported ever receiving HIV testing . Also
using NHIS data, CDC reported that among persons aged 18–64
years in 2009, 45.0% (82.9 million) reported ever receiving an
HIV test . While this increase is encouraging, it still means that
by 2009, 55% of persons aged 18–64 years had never received an
HIV test. These numbers will need to increase at a faster rate to
meet the National HIV/AIDS Strategy goal of increasing the
percentage of persons with HIV who are aware of their status to
90% by 2015 . In addition to the increased resources needed
to implement routine HIV testing, the identification of new HIV
cases will require linkages to HIV care and treatment resulting in
in further demand on our nation’s health care system. However,
these additional resources required in the short-term will result in
savings in costs and lives in the long-term.
There are several limitations to our study. Cost constraints
prohibited selecting all 2,550 individual providers participating in
the 2007 MMP data collection cycle. Our response rate of 42%
was low; however, our sample included mostly physicians, who
have lower survey response rates compared to non-physicians .
Results are based on providers’ self-reported responses to survey
questions. Given that these are providers of HIV care with the
majority caring for patients .10 years, who consider themselves
experts in and knowledgeable of HIV treatment, we expected high
rates of screening to be offered to their HIV-negative patients.
Providers’ estimates of the number of HIV-infected patients they
provide care to and the racial, ethnic and behavioral character-
istics of their HIV-infected patient populations were likely self-
determined and not derived using clinic records. We have
previously experienced errors in estimates of patient loads during
the construction of facility sampling frames in MMP .
Providers sampled and who responded to the survey may not be
representative of HIV care providers in the US, and therefore,
results may not be generalizable. We recommend that provider
surveys that are conducted in the future as part of MMP include
all sampled providers and that analysis weights are incorporated to
adjust for selection probabilities and nonresponse.
Although providers of HIV care likely have an increased
awareness of the benefits of routine HIV screening and early
identification of HIV-infected patients, many are still conducting
risk-based rather than routine testing. Among HIV care providers
surveyed, we found that provider profession, age, race, and HIV-
infected patient load were associated with offering HIV testing.
Based on our finding that 60% of HIV care providers reported
offering routine HIV testing to all patients, we recommend that
health care providers 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 to
increase the number of patients tested. Organizations for HIV
medical professionals are uniquely suited to increase awareness of
the guidelines and encourage their members to routinely offer
HIV testing to their patients. Assessing and reporting HIV testing
practices at the state and local level could also provide an
opportunity to increase awareness and monitor adherence to the
guidelines, particularly among providers with few or no HIV-
infected patients. The existing health care system will require
additional resources to fully implement the recommendations to
provide routine opt-out HIV testing. Resources will be needed not
only to conduct additional tests, but to provide medical care to the
increased number of persons with newly diagnosed HIV infection.
However, the increased initial costs of routine HIV testing can be
offset by the improved health outcomes associated with identifying
HIV early in the disease course, providing timely entry into
medical care, and the potential to prevent new infections through
suppression of HIV viral load and patients’ awareness of their HIV
We would like to thank the MMP Provider Survey participants, the MMP
staff in the 26 participating project areas, and the Clinical Outcomes Team
in CDC’s Behavioral and Clinical Surveillance Branch.
Disclaimer: The findings and conclusions in this paper are those of the
authors and do not necessarily represent the views of the Centers for
Disease Control and Prevention.
Conceived and designed the experiments: ADM EEV JMB CHJ PSS.
Analyzed the data: EEV CHJ. Wrote the paper: ADM EEV JMB CHJ
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