ECPN Student Poster Contestant: Missed Opportunities for HIV Testing Among a High-Risk Population of STD Clinic Patients

Background: HIV testing is a cornerstone of HIV prevention. The current HIV testing guidelines recommend that all adolescents and adults aged 13-64 be routinely screened for HIV in healthcare settings. Sexually transmitted disease (STD) clinic patients represent a population at increased risk for HIV infection, justifying more frequent risk assessment and testing for HIV. The purpose of this secondary analysis is to describe missed opportunities for HIV testing among a sample of high-risk STD clinic patients. This will help to identify areas of healthcare service delivery where the implementation of HIV testing and prevention services can be improved.

Methods: Descriptive analysis was conducted using data collected from Project Aware, a randomized trial of 5,012 adult patients from 9 STD clinics in the United States, enrolled from April to December 2010. History of HIV testing, access and utilization of healthcare services, and information about behavioral risks were obtained through audio computer-assisted self-interview (ACASI) at baseline. Missed opportunities for HIV testing, defined as having a healthcare visit but no history of HIV testing in the last 12 months, were characterized by type, location, and frequency. Sub-analyses were conducted for participants who tested HIV-positive at baseline and for high-risk participants meeting criteria for repeat testing according to national testing guidelines.

Results: A total of 2,315 (46.2%) STD clinic patients had not tested for HIV in the last 12 months, including 616 (12.3%) never-testers. Of these, 1,715 (74.1%) reported at least one visit to a healthcare provider in the last 12 months, representing a missed testing opportunity. Missed opportunities in clinical settings occurred most frequently among participants reporting family doctor visits (40.7%), other medical doctor visits (34.9%), and dental visits (21.1%). In non-traditional healthcare settings, missed opportunities were most frequently reported among participants who had been incarcerated (45.2%) and those reporting psychologist visits (43.3%). Of the 53 participants who were diagnosed with HIV at baseline, 16 (30.2%) had a missed opportunity for testing. There were 2,284 (45.5%) participants considered high-risk for HIV infection. Of these, 1,245 (54.5%) were not tested for HIV in the last 12 months, of which 932 (74.9%) reported at least one healthcare visit.

Conclusion: Missed opportunities for HIV testing were common in this population of high-risk STD clinic patients. Additionally, missed opportunities for HIV diagnosis were identified. Prevention programs should strive to increase routinized HIV testing in a broader range of healthcare settings, including primary care settings and correctional facilities.