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Siddiqi KA, Gwynn M, Olatosi B, Ostermann J. Associations Between Clinic-Based HIV Testing Guidelines and Population-Level HIV Testing Rates in the United States. J Assoc Nurses AIDS Care 2023; 34:349-362. [PMID: 37141167 DOI: 10.1097/jnc.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT Between 2005 and 2006, the United States Preventive Services Task Force and the Centers for Disease Control and Prevention revised their risk-based HIV testing guidelines to include universal HIV testing in routine health care. We examined trends in HIV testing and associations with changing policy recommendations using the 2000-2017 National Health Interview Surveys. Multivariable logistic regression and difference-in-difference approach were used to assess rates and correlates of HIV testing before and after the policy changes. Changes in recommendations had minimal effects on overall HIV testing rates but had significant effects on selected subpopulations. The odds of HIV testing increased disproportionately among African Americans, Hispanics, individuals with some college education, low perceived HIV risks, and those who were never married but decreased among those with no regular source of care. A strategy combining risk-based and routine opt-out testing holds promise to rapidly link recently infected individuals to care while reaching individuals who have never been tested.
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Affiliation(s)
- Khairul A Siddiqi
- Khairul A Siddiqi, PhD, Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA. Melanie Gwynn, PhD, MPH, MHA, Department of Health Services Policy & Management, University of South Carolina, Columbia, South Carolina, USA, and South Carolina Rural Health Research Center, Columbia, South Carolina, USA. Bankole Olatosi, PhD, Department of Health Services Policy & Management, University of South Carolina, Columbia, South Carolina, USA. Jan Ostermann, PhD, Department of Health Services Policy & Management, University of South Carolina, Columbia, South Carolina, USA
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2
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Xu CX, Xu Y. HIV testing among LGBTQIA+ individuals: the impact of outness and peer openness. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2022. [DOI: 10.1080/02673843.2022.2152718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Chang X. Xu
- Department of Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA
| | - Yaoying Xu
- Department of Counseling and Special Education, Virginia Commonwealth University, Richmond, VA, USA
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3
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Gousse Y, Wilson TE, McFarlane D, Browne RC, Fraser M, Yusim D, Stewart M, Salifu MO, Joseph MA. HIV Testing Correlates: U.S. and Foreign Born High-Risk Black Heterosexual Men. J Immigr Minor Health 2021; 23:1145-1151. [PMID: 33507520 PMCID: PMC9796172 DOI: 10.1007/s10903-021-01140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/30/2022]
Abstract
In the U.S., Black men are disproportionately affected by HIV, with some of the highest HIV incidence rates and lowest rates of HIV testing. We examined correlates of HIV testing and knowledge among participants of the Barbershop Talk with Brothers (BTWB) project, an HIV prevention program targeting high-risk sexual behaviors among Black heterosexual men in Brooklyn, New York. Specifically, we examined differences between U.S. vs. foreign-born status and HIV testing rates, HIV knowledge, and socio-demographic factors. Of the 855 men included, the mean age was 33 years and 35.0% were foreign-born. Lifetime HIV testing was reported at 84%, with greater proportion of U.S. vs foreign-born men reporting lifetime (88.6% vs. 75.0%) and recent testing (68.6% vs. 51.0%), p < 0.001. Among foreign-born men, recent HIV testing was associated with lower stigma and greater HIV transmission knowledge than those un-tested. The authors recommend tailored approaches to increasing HIV testing in Black communities, based on nativity and social factors.
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Affiliation(s)
- Yolene Gousse
- Department of Pharmacy Administration and Public Health, St. John’s University, Queens, NY, USA,Brooklyn Health Disparities Center, Brooklyn, NY, USA,Department of Pharmacy Administration and Public Health, Dr. Andrew J. Bartilucci Center, St. John’s University, 8000 Utopia Parkway, New York, NY 11439, USA
| | - Tracey E. Wilson
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Davin McFarlane
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,Special Treatment and Research Program, College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - Marilyn Fraser
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,Arthur Ashe Institute for Urban Health, Brooklyn, NY, USA
| | - Diana Yusim
- Baystate Medical Center, Springield, MA, USA
| | - Mark Stewart
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,School of Graduate Studies, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Moro O. Salifu
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,Division of Nephrology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Michael A. Joseph
- Brooklyn Health Disparities Center, Brooklyn, NY, USA,Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Williford SL, Humes E, Greenbaum A, Schumacher CM. HIV Screening Among Gonorrhea-Diagnosed Individuals; Baltimore, Maryland; April 2015 to April 2019. Sex Transm Dis 2021; 48:42-48. [PMID: 33319970 DOI: 10.1097/olq.0000000000001252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Individuals diagnosed with gonorrhea are at elevated risk for HIV. Per US Centers for Disease Control and Prevention guideline, individuals being evaluated for gonorrhea should be screened for HIV concurrently. There is limited information on HIV screening among gonorrhea-diagnosed individuals across different health care settings. Our objective was to identify potential gaps in HIV screening among gonorrhea-diagnosed individuals in Baltimore City, Maryland. METHODS We used Sexually Transmitted Disease Surveillance Network project data collected on a random sample of all gonorrhea diagnoses reported to the health department between April 2015 and April 2019. Individuals with known HIV diagnoses were excluded. HIV screening was confirmed through surveys administered to the gonorrhea-diagnosing provider. HIV screening across groups was assessed using Poisson regression models with robust SEs. We examined those with and without recent (≤12 months) sexually transmitted infection (STI) history separately. RESULTS Among 2830 gonorrhea-diagnosed individuals with completed Sexually Transmitted Disease Surveillance Network provider surveys, less than half (35.2% with and 44.8% without recent STI history) received concurrent HIV screening. HIV screening was 73% less prevalent among those diagnosed in emergency departments/urgent care centers/hospitals versus sexual health clinics (with and without recent STI history: adjusted prevalence ratio, 0.27 [95% confidence interval, 0.19-0.39]; adjusted prevalence ratio, 0.27 [0.23-0.33]), controlling for diagnosis year, sex, race/ethnicity, age, infection site, and insurance. CONCLUSIONS Our findings suggest a considerable gap in HIV screening among individuals at elevated risk for HIV acquisition in Baltimore City, particularly among those diagnosed in emergency departments/urgent care centers/hospital settings. Future work should focus on identifying provider-level barriers to concurrent HIV/STI screening to inform provider education programs.
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Affiliation(s)
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Kabapy AF, Shatat HZ, Abd El-Wahab EW. Attributes of HIV infection over decades (1982-2018): A systematic review and meta-analysis. Transbound Emerg Dis 2020; 67:2372-2388. [PMID: 32396689 DOI: 10.1111/tbed.13621] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 01/19/2023]
Abstract
Understanding the risk factors for HIV infection is the foundation of successful preventive strategies, which must bundle sociocultural, behavioural and biomedical interventions to halt disease transmission. We aimed in this study to provide a pooled estimation of HIV risk factors and trace changes across decades in order to drive consensus and accurate assessment of disease transmission risk. We comprehensively searched PubMed, ISI Web of Knowledge, Medline, EMBASE, ScienceDirect, Ovid, EBSCO, Google Scholar and the Egyptian Universities Library Consortium from October to December 2018. Two independent reviewers extracted data from eligible studies. Funnel plots were inspected to identify publication bias. Heterogeneity across studies was checked using the Q and I2 statistics. The results were reported based on the pooled odds ratio (pOR) with 95% CI using a random-effects model. Meta-analysis of HIV risk factors revealed a superior role for risky sexual practices (unprotected vaginal/anal sex), injecting drug use (IDU), sharing needles, sexually transmitted infections (STIs), child sexual abuse and vertical transmissions. Trends across decades (1982-1999 and 2000-2018, respectively) showed rising evidence for prostitution [pOR (95% CI)= 2.3 (1.12-4.68) versus 2.69 (1.67-4.32)] and men who have sex with men (MSM) [pOR (95% CI)= 2.28 (1.64-3.17) versus 3.67 (1.88-7.17)], while transmission through IDU [pOR (95% CI)= 3.42 (2.28-5.12) versus 2.16 (1.74-2.70)], alcoholism [pOR (95% CI)= 2.35 (0.73-7.59) versus 1.71(1.08-2.72)], and sharing syringes [pOR (95% CI)= 6.10 (2.57-14.5) versus 2.70 (2.01-6.35)] showed notable decline. Harm reduction programs and condom use have been recognized as chief HIV prevention strategies, while male circumcision contributed a partial role. Collectively, sexual risk factors continue to be a key driver of the global HIV epidemic. Persistent and emerging risk factors identified in our analysis should constitute the forefront targets of HIV prevention programmes to accelerate efforts towards HIV elimination.
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Affiliation(s)
- Ahmed F Kabapy
- Fellow of Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.,Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, Alexandria, Egypt
| | - Hanan Z Shatat
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ekram W Abd El-Wahab
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Tran L, Tran P, Tran L. Influence of Rurality on HIV Testing Practices Across the United States, 2012-2017. AIDS Behav 2020; 24:404-417. [PMID: 30762188 DOI: 10.1007/s10461-019-02436-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In the US, HIV testing has been key in the identification of new HIV cases, allowing for the initiation of antiretroviral treatment and a reduction in disease transmission. We consider the influence of living in a rural area (rurality) on HIV testing between different US regions and states as existing work in this area is limited. Using the 2012-2017 Behavioral Risk Factor Surveillance Systems surveys, we explored the independent role of rurality on having ever been tested for HIV and having a recent HIV test at the national, regional, and state levels by calculating average adjusted predictions (AAPs) and average marginal effects (AMEs). Suburban and urban areas had higher odds and AAPs of having ever been tested for HIV and having a recent HIV test compared to rural areas across the US. The Midwest had the lowest AAPs for both having ever been tested for HIV (17.57-20.32%) and having a recent HIV test (37.65-41.14%) compared to other regions. For both questions on HIV testing, regions with the highest AAPs had the greatest rural-urban differences in probabilities and regions with the lowest AAPs had the smallest rural-urban difference in probabilities. The highest rural-urban testing disparities were observed in states with high AAPs for HIV testing. HIV testing estimates were higher in urban compared to rural areas at the national, regional, and state level. This study examines the isolated influence of rurality on HIV testing and identifies specific US areas where future efforts to increase HIV testing should be directed to.
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Traynor SM, Rosen-Metsch L, Feaster DJ. Missed Opportunities for HIV Testing Among STD Clinic Patients. J Community Health 2019; 43:1128-1136. [PMID: 29796786 DOI: 10.1007/s10900-018-0531-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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, justifying more frequent risk assessment and testing. This analysis describes missed opportunities for HIV testing among a sample of STD clinic patients to identify areas where HIV testing services may be improved. Secondary analysis was conducted using data from Project AWARE, a randomized trial of 5012 adult patients from 9 STD clinics in the United States, enrolled April-December 2010. HIV testing history, healthcare service utilization, and behavioral risks were obtained through audio computer-assisted self-interview. Missed opportunities for HIV testing, defined as having a healthcare visit but no HIV test in the last 12 months, were characterized by location and frequency. Of 2315 (46.2%) participants not tested for HIV in the last 12 months, 1715 (74.1%) had a missed opportunity for HIV testing. These missed opportunities occurred in both traditional (54.9% at family doctor, 20.3% at other medical doctor visits) and non-traditional (28.5% at dental, 19.0% at eye doctor, 13.9% at correctional facility, and 13.3% at psychology visits) testing settings. Of 53 participants positive for HIV at baseline, 16 (30.2%) had a missed testing opportunity. Missed opportunities for HIV testing were common in this population of STD clinic patients. There is a need to increase routinized HIV screening and expand testing services to a broader range of healthcare settings.
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Affiliation(s)
- Sharleen M Traynor
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1066, Miami, FL, 33136, USA.
| | - Lisa Rosen-Metsch
- School of General Studies, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1059, Miami, FL, 33136, USA
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Rural-Urban Differences in Human Immunodeficiency Virus Testing Among US Adults: Findings From the Behavioral Risk Factor Surveillance System. Sex Transm Dis 2019; 45:808-812. [PMID: 29965946 DOI: 10.1097/olq.0000000000000888] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals in rural areas of the United States face barriers to human immunodeficiency virus (HIV)-related health care. We aim to assess differences in frequency of lifetime and past-year HIV testing, and differences in testing site location between rural and urban residents of the United States. METHODS Data from the Behavioral Risk Factor Surveillance System 2015 were analyzed on 250,579 respondents 18 years or older. Weighted multinomial logistic regression analyses compared urban/rural differences in lifetime and past-year HIV testing. Weighted multinomial logistic regression compared urban/rural differences in HIV testing site. RESULTS Overall, 26.9% of urban residents and 21.5% of rural residents reported testing for HIV in their lifetime. Of urban residents, 24.5% reported receiving an HIV test in the past year compared with 20.2% of rural residents. Living in a rural area was associated with lower odds of lifetime (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.81-0.90) and past-year HIV testing (OR, 0.84; 95% CI, 0.74-0.95) compared with not testing. Rural residents had higher odds of receiving an HIV test at the hospital or emergency room (adjusted OR, 1.41; 95% CI, 1.23-1.62) or clinic (adjusted OR, 1.21; 95% CI, 1.02-1.24) than a doctor's office. CONCLUSIONS This study highlights significant rural health disparities in rates of lifetime and past-year HIV testing. Targeted interventions are needed to remove structural barriers in rural communities, such as long distances to clinics and low availability of free HIV testing at clinics serving the uninsured or underinsured. Furthermore, rural providers should be encouraged to routinely offer HIV screening to their patients.
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Dillon FR, Eklund A, Ebersole R, Ertl MM, Martin JL, Verile MG, Gonzalez SR, Johnson S, Florentin D, Wilson L, Roberts S, Fisher N. Heterosexual Self-Presentation and Other Individual- and Community-Based Correlates of HIV testing among Latino Men Who Have Sex With Men. PSYCHOLOGY OF MEN & MASCULINITY 2019; 20:238-251. [PMID: 31592191 PMCID: PMC6779342 DOI: 10.1037/men0000166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
From 2010 to 2014, HIV diagnoses among Latino men who have sex with other men (LMSM) have increased by 14%, while diagnoses declined by 11% among white, non-Latino MSM. This health disparity is in part due to exposure to other LMSM with undiagnosed HIV infections. To effectively engage LMSM who are unaware of their serostatus, profiles of men differing in theorized determinants of HIV testing must be considered. In this retrospective study, we examined data from 546 LMSM to investigate whether hypothesized individual- (traditional masculine gender role conformity; sexual identity development status; alcohol and illicit drug use; sexual risk behaviors; perceived HIV susceptibility; and HIV stigma) and community-based (HIV prevention programming, access to health care, social support, neighborhood collective efficacy) factors were associated with differences in HIV testing. Latent profile analysis was used to identify profiles of men, and subsequent analyses examined whether profiles exhibited differential proportions of HIV testing. Four latent profiles were observed. One profile (50.3% tested) differed markedly from all other profiles (5.1 to 11% tested) in HIV testing. Characteristics of participants in this unique profile included reporting lower levels of heterosexual self-presentation, sexual identity uncertainty (and high levels of sexual identity commitment), condom use, HIV stigma, education, and perceived HIV susceptibility than all other profiles. Findings could improve HIV testing rates among LMSM by specifying ways in which public health advertisements/campaigns and community-based testing outreach efforts could be tailored to men most at-risk for transmitting HIV due to unknown serostatus.
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Cushman TA, Graves SK, Little SJ. Attitudes and Preferences Regarding the Use of Rapid Self-Testing for Sexually Transmitted Infections and HIV in San Diego Area Men Who Have Sex With Men. Open Forum Infect Dis 2019; 6:ofz043. [PMID: 30906798 PMCID: PMC6424479 DOI: 10.1093/ofid/ofz043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/03/2019] [Indexed: 01/04/2023] Open
Abstract
Background Sexually transmitted infections (STIs) increase the risk of HIV transmission and are present at high rates among men who have sex with men (MSM). Adherence to HIV/STI testing guidelines is low in the United States. Testing programs that utilize rapid self-administered HIV/STI tests improve testing rates, though multiple factors influence their uptake. Methods MSM were recruited at an HIV/STI testing and treatment program in 2014 and provided consent, demographics, risk behaviors, HIV/STI test preferences, and perceived testing barriers via an online questionnaire. Comparisons of testing preferences and barriers were made based on age, risk group, and HIV serostatus using the Fisher exact test. Results HIV testing preferences included rapid oral test (71.1%), home test location (78.5%), electronic delivery of HIV-negative test results (76.4%), and direct provider notification for HIV-positive test results (70%), with respondents age >45 years being significantly more likely to prefer home testing (P = .033). STI testing preferences included self-collection of specimens (73.2%), home test location (61%), electronic delivery of negative STI test results (76.4%), and direct provider notification for positive STI test results (56.6%) with no significant differences between age, HIV serostatus, or risk groups. The most frequently reported HIV and STI testing barrier was lack of known prior HIV/STI exposure (57.3% for HIV, 62.9% for STI) with respondents age <45 years more frequently citing inconvenience as a barrier to testing (HIV: 50.9% vs 17.4%, P = .010; STI: 58.3% vs 31.8%, P = .070). Conclusions Although additional research is needed, increasing resources directed specifically toward home testing has the potential to translate into improved uptake of rapid HIV/STI testing. Efforts to improve convenience in testing programs must be balanced with the need for continued educational outreach.
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Affiliation(s)
- Teresa A Cushman
- Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado
| | - Susannah K Graves
- Division of Infectious Diseases, University of California San Diego, San Diego, California
| | - Susan J Little
- Division of Infectious Diseases, University of California San Diego, San Diego, California
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Hechter RC, Bider-Canfield Z, Towner W. Effect of an Electronic Alert on Targeted HIV Testing Among High-Risk Populations. Perm J 2019; 22:18-015. [PMID: 30285916 DOI: 10.7812/tpp/18-015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Screening for HIV infection in medical settings remains suboptimal. OBJECTIVE To examine the real-world effectiveness of an electronic clinician alert on the same-day HIV testing rate and early diagnosis in high-risk populations. DESIGN We identified Kaiser Permanente Southern California Health Plan members aged 14 years or older who received tests for sexually transmitted infections. MAIN OUTCOME MEASURES Encounter-based same-day HIV testing rate, positive test result rate, and CD4+ cell count and HIV viral load at diagnosis. RESULTS We identified 1,800,948 patients who made 2,326,701 health care encounters eligible for HIV testing before implementation (January 1, 2008 - June 30, 2012) and 1,362,479 eligible encounters after implementation (January 1, 2013 - June 30, 2015). The same-day HIV testing rate increased from 36.7% to 44.1% (standardized mean difference = 0.15, significant difference). The alert was associated with a moderate difference and statistically significant increase in the HIV testing rate (adjusted odds ratio = 1.17, 95% confidence interval = 1.16-1.18). The positive test result rate increased from 0.02% to 0.04% (p < 0.001). During the postimplementation period, fewer HIV-infected patients had a CD4+ cell count below 200 and/or an HIV viral load of 10,000 copies/mL or higher at diagnosis. CONCLUSION Implementation of a targeted electronic alert embedded in the electronic medical record improved same-day HIV screening rate and positive test result rates among patients receiving tests for sexually transmitted infections in a large health organization. This intervention has potential for facilitating frequent screening and early identification of HIV infection in high-risk populations.
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Affiliation(s)
- Rulin C Hechter
- Research Scientist and Epidemiologist at the Kaiser Permanente Southern California Department of Research and Evaluation in Pasadena
| | - Zoe Bider-Canfield
- Biostatistician at the Kaiser Permanente Southern California Department of Research and Evaluation in Pasadena
| | - William Towner
- Regional Physician Director for Clinical Trials at the Kaiser Permanente Southern California Department of Research and Evaluation in Pasadena
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Nelson KM, Pantalone DW, Gamarel KE, Carey MP, Simoni JM. Correlates of Never Testing for HIV Among Sexually Active Internet-Recruited Gay, Bisexual, and Other Men Who Have Sex with Men in the United States. AIDS Patient Care STDS 2018; 32:9-15. [PMID: 29232170 PMCID: PMC5756935 DOI: 10.1089/apc.2017.0244] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the United States, gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by the HIV/AIDS epidemic. Despite great strides in HIV prevention, including biobehavioral HIV prevention strategies such as pre-exposure prophylaxis and treatment as prevention, there has been relatively low uptake of these strategies. The success of biobehavioral prevention strategies requires HIV testing but a subset of GBMSM have never been tested. To optimize prevention efforts, we sought to understand the characteristics of GBMSM who report never testing for HIV. A sample of GBMSM was recruited online in 2012 to complete a cross-sectional survey of sexual behavior and sexual health. Bivariate and multivariable analyses were used to identify characteristics of "never testing for HIV." Of the 1170 participants, 151 (13%) reported never testing for HIV. In multivariable analyses, younger age, less education, endorsing a non-gay sexual identity, living in rural areas, not having a primary partner, living in unstable housing, and reporting regular condom use during anal sex were independently associated with never testing. We conclude that, despite a substantial focus on HIV testing among GBMSM in the United States, a proportion of sexually active, adult GBMSM report never having tested for HIV in their lifetimes. The current study illustrates the importance of addressing individual and structural factors that serve as barriers to HIV testing among GBMSM. Addressing these barriers will improve access to HIV testing and other biobehavioral HIV prevention strategies and, ultimately, alleviate disparities in HIV/AIDS in the United States.
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Affiliation(s)
- Kimberly M Nelson
- 1 Centers for Behavioral and Preventative Medicine , The Miriam Hospital, Providence, Rhode Island
- 2 Department of Psychiatry and Human Behavior, Brown University , Providence, Rhode Island
- 3 Department of Behavioral and Social Sciences, Brown University , Providence, Rhode Island
| | - David W Pantalone
- 4 Department of Psychology, University of Massachusetts , Boston, Massachusetts
- 5 The Fenway Institute , Fenway Health, Boston, Massachusetts
- 6 Center for Alcohol and Addiction Studies, Brown University , Providence, Rhode Island
| | - Kristi E Gamarel
- 3 Department of Behavioral and Social Sciences, Brown University , Providence, Rhode Island
- 7 Department of Health Behavior and Health Education, University of Michigan School of Public Health , Ann Arbor, Michigan
| | - Michael P Carey
- 1 Centers for Behavioral and Preventative Medicine , The Miriam Hospital, Providence, Rhode Island
- 2 Department of Psychiatry and Human Behavior, Brown University , Providence, Rhode Island
- 3 Department of Behavioral and Social Sciences, Brown University , Providence, Rhode Island
| | - Jane M Simoni
- 8 Department of Psychology, University of Washington , Seattle, Washington
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Noble M, Jones AM, Bowles K, DiNenno EA, Tregear SJ. HIV Testing Among Internet-Using MSM in the United States: Systematic Review. AIDS Behav 2017; 21:561-575. [PMID: 27498198 DOI: 10.1007/s10461-016-1506-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Regular HIV testing enables early identification and treatment of HIV among at-risk men who have sex with men (MSM). Characterizing HIV testing needs for Internet-using MSM informs development of Internet-facilitated testing interventions. In this systematic review we analyze HIV testing patterns among Internet-using MSM in the United States who report, through participation in an online study or survey, their HIV status as negative or unknown and identify demographic or behavioral risk factors associated with testing. We systematically searched multiple electronic databases for relevant English-language articles published between January 1, 2005 and December 16, 2014. Using meta-analysis, we summarized the proportion of Internet-using MSM who had ever tested for HIV and the proportion who tested in the 12 months preceding participation in the online study or survey. We also identified factors predictive of these outcomes using meta-regression and narrative synthesis. Thirty-two studies that enrolled 83,186 MSM met our inclusion criteria. Among the studies reporting data for each outcome, 85 % (95 % CI 82-87 %) of participants had ever tested, and 58 % (95 % CI 53-63 %) had tested in the year preceding enrollment in the study, among those for whom those data were reported. Age over 30 years, at least a college education, use of drugs, and self-identification as being homosexual or gay were associated with ever having tested for HIV. A large majority of Internet-using MSM indicated they had been tested for HIV at some point in the past. A smaller proportion-but still a majority-reported they had been tested within the year preceding study or survey participation. MSM who self-identify as heterosexual or bisexual, are younger, or who use drugs (including non-injection drugs) may be less likely to have ever tested for HIV. The overall findings of our systematic review are encouraging; however, a subpopulation of MSM may benefit from targeted outreach. These findings indicate unmet needs for HIV testing among Internet-using MSM and identify subpopulations that might benefit from targeted outreach, such as provision of HIV self-testing kits.
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Affiliation(s)
- Meredith Noble
- Hayes, Inc., 157 S. Broad Street, Lansdale, PA, 19446, USA.
| | | | - Kristina Bowles
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth A DiNenno
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Linley L, An Q, Song R, Valverde E, Oster AM, Qian X, Hernandez AL. HIV Testing Experience Before HIV Diagnosis Among Men Who Have Sex with Men - 21 Jurisdictions, United States, 2007-2013. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:999-1003. [PMID: 27657179 DOI: 10.15585/mmwr.mm6537a3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) continue to be the population most affected by human immunodeficiency virus (HIV) in the United States. In 2014, 81% of diagnoses of HIV infection were among adult and adolescent males, and among these, 83% of infections were attributable to male-to-male sexual contact (1). Since 2006, CDC has recommended HIV testing at least annually for sexually active MSM to foster early detection of HIV infection and prevent HIV transmission (2,3). Several initiatives and strategies during the past decade have aimed to expand HIV testing among MSM to increase early diagnosis and treatment and reduce transmission. To better understand HIV testing patterns among MSM with diagnosed HIV infection, CDC analyzed data for 2007-2013 from jurisdictions conducting HIV incidence surveillance as part of CDC's National HIV Surveillance System (NHSS). Findings from this analysis suggest that increasing percentages of MSM have had a negative HIV test during the 12 months before diagnosis (48% in 2007, 56% in 2013, among those with a known date of previous negative HIV test), indicating a trend toward increased HIV testing and earlier HIV diagnosis among persons most at risk for HIV.
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Affiliation(s)
- Laurie Linley
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Qian An
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Ruiguang Song
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Eduardo Valverde
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Alexandra M Oster
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Xiaona Qian
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Angela L Hernandez
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
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15
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Kelly BC. Reconsidering "Unprotected" and HIV Risk in the Twenty-First Century. Front Immunol 2016; 7:209. [PMID: 27377578 PMCID: PMC4896945 DOI: 10.3389/fimmu.2016.00209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/16/2016] [Indexed: 11/23/2022] Open
Affiliation(s)
- Brian C Kelly
- Sociology, Purdue University , West Lafayette, IN , USA
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