Many, if not most, opportunities for HIV testing during ambulatory care visits are missed in the U.S., a study published in Morbidity and Mortality Weekly Report showed.
The findings are based on data from two large national surveys spanning several years (2009 to 2016 for one, 2009 to 2017 for the other) and involving a total of 516 million physician’s office visits, 87 million emergency department visits, and 37 million community health center visits. Researchers determined that the proportion of ambulatory care visits during which an HIV test was ordered rose over time at community health centers and emergency departments, but did not improve at physician’s offices.
Despite increased testing in some settings, overall rates still topped out at just 2.65% for visits to community health centers. Yet by comparison to other settings, that percentage was high: In emergency departments and at doctor’s offices, fewer than 1% of encounters with non-pregnant people were associated with an HIV test. Opt-out HIV testing has been recommended as a part of routine health care in the U.S. since 2006, with annual testing recommended for high-risk individuals.
Testing was found to be more likely during preventive rather than acute care visits, as well as in cases where blood was already being drawn for another reason.
These missed opportunities for HIV testing are especially problematic for populations disproportionately affected by the virus, such as young Black and Latino men or people who inject drugs, study authors noted. They recommended decision support tools in the electronic health record to prompt the physician and routine opt-out testing in emergency departments and similar settings.
“To end the HIV epidemic, testing of patients seeking care in ambulatory health care settings should be leveraged to increase the percentage of diagnosed infections and reduce HIV transmission,” the authors concluded.