HIV Testing Implementation in Two Urban Cities: Practice, Policy, and Perceived Barriers

Abstract

BackgroundAlthough funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown.MethodsWe conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions.ResultsIn 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% of Department of Health-supported testers in Houston. The median number of tests per organization was 568 in DC and 1045 in Houston. Approximately 50% of organizations in both DC and Houston exclusively used opt-in consent and most conducted both pre- and post-test counseling with HIV testing (80% of organizations in DC, 70% in Houston). While the most frequent source of funding in DC was the Department of Health, Houston organizations primarily billed the patient or third-party payers. Barriers to testing most often reported were lack of funding, followed by patient discomfort/refusal with more barriers reported in DC.ConclusionsGiven unique policies, resources and programmatic contexts, DC and Houston have taken different approaches to support routine testing. Many organizations in both cities reported opt-in consent approaches and pre-test counseling, suggesting 2006 national HIV testing recommendations are not being followed consistently. Addressing the barriers to testing identified in each jurisdiction may improve expansion of testing.

Racial and sex disparities in HIV screening outcomes within emergency departments of Harris County, Texas

“…The overall project was implemented in non‐traditional venues across the United States, including EDs, to address the HIV epidemic at a population level. Routine HIV testing in the ED affords clinicians and public health practitioners access to a network of individuals who often times have significant HIV and sexually transmitted infections risk nationally and locally 12‐14 . The expansion of HIV testing to the ED was integrated with linkage to care offered by our partners at the Houston Health Department.…”

Feasibility of Using HIV Care-Continuum Outcomes to Identify Geographic Areas for Targeted HIV Testing

“…Significant declines in new HIV diagnoses over recent years have been achieved concurrent with the widespread scale-up of routine HIV testing, comprehensive linkage and retention in care programs, and universal access to care [23–26]; however, measurement of care-continuum outcomes and CVL continue to identify gaps in meeting the NHAS and UNAIDS 90-90-90 goals. The DC HIV care continuum suggests that as many as 25–30% of infected people are unaware of their infections [27–29].…”

Update on the Epidemiology and Prevention of HIV/AIDS in the USA

“…Routine HIV testing in medical settings has been the standard recommendation from CDC since 2006, and linkage to care rates are relatively high when coupled with testing. Many high prevalence cities, including the Bronx, New York, 46 Washington, DC, 47 Houston, Texas, 48 and Philadelphia, Pennsylvania 49 have already implemented routine HIV testing programs in response to the revised CDC recommendations and have all been able to test and identify thousands of infected persons. Home-based HIV testing and internet-based HIV counseling offer new opportunities to identify persons unaware of their infection.…”