HIV testing in a high prevalence urban area in the US: Identifying missed opportunities two ways

Abstract

Background Routine opt-out HIV testing in healthcare settings is often not implemented to its fullest extent. We assessed factors contributing to missed HIV testing opportunities at an academic medical center in Chicago, Illinois, with a routine HIV screening program. Methods Retrospective analysis of HIV testing in clinical encounters was performed using multivariate regession models. Missed opportunities were defined as 1) an encounter during which an HIV test was not conducted on a patient later diagnosed with HIV, or 2) an encounter in which a bacterial STI test was performed without HIV testing. Results Of 122 people newly diagnosed with HIV from 2011-2018, 98 patients had 1215 prior encounters, of which 82.8% were missed opportunities. Female gender, persons not known to be men who have sex with men, and encounter location other than inpatient had higher odds of a missed opportunity. Nearly half (48.4%) of 104,678 bacterial STI testing encounters were missed opportunities. Female gender, older age, lack of syphilis testing, and location outside the emergency department had higher odds of a missed opportunity. Conclusions We found a high number of missed HIV testing opportunities, which could be reduced by strengthening routine screening and increasing targeted testing concurrent with STI screening.

Undiagnosed HIV in Patients on Immunosuppressive Medications Presenting with HIV-Associated Kidney Disease

“…Many at-risk or disproportionately affected groups may not receive or be offered appropriate HIV testing at their healthcare encounters. [14][15][16] This increases the challenges that patients face trying to access HIV testing. This is particularly harmful in the US South, where patients already experience higher rates of poverty, a lower proportion of HIV providers, and more limited access to health insurance due to a lack of Medicaid expansion.…”

“…There is conflicting evidence in the literature on whether linkage to HIV care is more effective in specific clinical settings (eg, primary care, urgent care, inpatient units) than others. 16,21,22 Admitted patients represent a potential missed opportunity for testing. 16,23 Providing opt-out HIV counseling and testing in all inpatient hospital settings has proven feasible in high-incidence populations while still allowing for a majority of newly diagnosed patients to be linked to care in both international and US contexts.…”

“…16,21,22 Admitted patients represent a potential missed opportunity for testing. 16,23 Providing opt-out HIV counseling and testing in all inpatient hospital settings has proven feasible in high-incidence populations while still allowing for a majority of newly diagnosed patients to be linked to care in both international and US contexts. 24,25 Nurses may be particularly effective when using this approach among admitted patients.…”

“…36 Ongoing experiences of discrimination have been associated with a lower likelihood of HIV testing among Black women. 15,16,37 Targeted interventions toward African American females using gender-or culture-specific materials, female speakers, and focused skills training sessions have been shown to be more effective at preventing HIV infection. 34,38 Using these targeted approaches may help normalize and overcome HIVrelated medical mistrust, IPV experiences, discrimination, and engrained stigma when counseling on HIV testing.…”

“…Many at-risk or disproportionately affected groups may not receive or be offered appropriate HIV testing at their healthcare encounters 14–16 . This increases the challenges that patients face trying to access HIV testing.…”