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Impact of a Routine, Opt-Out HIV Testing Program on HIV Testing and Case Detection in North Carolina Sexually Transmitted Disease Clinics

Klein, Pamela W. MSPH, PhD*†; Messer, Lynne C. PhD; Myers, Evan R. MD, MPH§; Weber, David J. MD, MPH*; Leone, Peter A. MD; Miller, William C. MD, PhD, MPH

Sexually Transmitted Diseases: June 2014 - Volume 41 - Issue 6 - p 395–402
doi: 10.1097/OLQ.0000000000000141
The Real World of STD Prevention

Background The impact of routine, opt-out HIV testing programs in clinical settings is inconclusive. The objective of this study was to estimate the impact of an expanded, routine HIV testing program in North Carolina sexually transmitted disease (STD) clinics on HIV testing and case detection.

Methods Adults aged 18 to 64 years who received an HIV test in a North Carolina STD clinic from July 1, 2005, through June 30, 2011, were included in this analysis, dichotomized at the date of implementation on November 1, 2007. HIV testing and case detection counts and rates were analyzed using interrupted time series analysis and Poisson and multilevel logistic regression.

Results Preintervention, 426 new HIV-infected cases were identified from 128,029 tests (0.33%), whereas 816 new HIV-infected cases were found from 274,745 tests postintervention (0.30%). Preintervention, HIV testing increased by 55 tests per month (95% confidence interval [CI], 41–72), but only 34 tests per month (95% CI, 26–42) postintervention. Increases in HIV testing rates were most pronounced in women and non-Hispanic whites. A slight preintervention decline in case detection was mitigated by the intervention (mean difference, 0.01; 95% CI, −0.02 to 0.05). Increases in case detection rates were observed among women and non-Hispanic blacks.

Conclusions The impact of a routine HIV screening in North Carolina STD clinics was marginal, with the greatest benefit among persons not traditionally targeted for HIV testing. The use of a preintervention comparison period identified important temporal trends that otherwise would have been ignored.

In North Carolina sexually transmitted disease clinics, the introduction of a routine, opt-out expanded HIV testing program had a minimal impact on HIV testing and case detection.

From the *Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI; †Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC; ‡School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR; §Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC; and ¶HIV/STD Prevention and Care Branch, North Carolina Division of Public Health, Raleigh, NC

Acknowledgments: The authors thank North Carolina Division of Public Health staff, including Evelyn Foust, Jacquelyn Clymore, Aaron Fleischauer, Del Williams, Vicky Mobley, Janet Alexander, Pete Moore, Jan Scott, and Lynne Sampson, and all sexually transmitted disease clinic staff and patients.

Support: This project was supported, in part, by an NRSA predoctoral training grant (T32-AI070114) from the National Institute of Allergy and Infectious Diseases, an NRSA postdoctoral training grant (T32-MH19985) from the National Institute of Mental Health, and Centers for Disease Control and Prevention PS 12-1201 (Comprehensive HIV Prevention Programs for Health Departments).

Conflict of interest: Dr Leone receives financial support from Abbott Diagnostics for university-sponsored research and speakers bureau. Dr Weber receives financial support from Pfizer (consultancy and speakers bureau), Merck (consultancy and speakers bureau), and Clorox (consultancy). None of the remaining authors have any conflicts of interest to disclose.

Correspondence: Pamela W. Klein, MSPH, PhD, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 North Summit Ave, Milwaukee, WI 53202. E-mail:

Received for publication October 30, 2013, and accepted April 9, 2014.

© Copyright 2014 American Sexually Transmitted Diseases Association