Assessing Provider Offers of HIV Testing in a High Risk Population

BACKGROUND:  Many HIV-positive persons are unaware of their infection status and are diagnosed and enter care late. To increase HIV screening, the CDC began recommending HIV screening for patients in all health care settings. Following these recommendations, in 2010, New York State enacted a law that requires HIV testing be offered at least once to all persons between the ages of 18 and 64 receiving medical care in primary care and hospital settings. For higher risk populations, testing should be done at least annually. This analysis assesses the levels of and factors associated with HIV test offers in a high risk population after the law was enacted.

METHODS:  Data are from the National HIV Behavioral Surveillance System (NHBS) conducted in Long Island, NY in a population of injecting drug users in 2012. For each type of health care setting visited (inpatient, emergency room, primary care, community health center, other) in the past year, participants were asked during face-to-face interviews if they were ever offered an HIV test. Bivariate associations between offers of an HIV test and socio-demographic factors were evaluated with Chi-square or Fisher’s exact test. Risk ratios and 95% confidence intervals were estimated from multivariate log binomial models.   

RESULTS:  Of 197 participants, a majority were low income, male, heterosexual, black, unemployed and had high school or less education. Overall, 64% of participants who visited a health care setting in the past year reported being offered an HIV test in at least one setting. The offer rate ranged from 39% in the primary care setting to 77% in the inpatient care setting. The percentage was significantly (p<.05) higher for those with high school or less education and those who had government medical insurance. However, in multivariate models we did not find that offer rates varied significantly by participant socio-demographic factors. For models by individual healthcare setting, we found that having less than a college education was associated with increased offers of HIV testing in the primary care and emergency department settings.

CONCLUSIONS:  Nearly two-thirds of this high risk sample were offered an HIV test in the past year, pointing to evidence of success in implementing the HIV test law. Still, about one-third was not offered an HIV test, and offers varied by participant socio-demographic factors and by healthcare setting. The results indicate a need for further provider and health care facility education about the HIV testing law.