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Original Research

HIV testing at a community health center before and after implementing universal screening

Kayingo, Gerald PhD, MMSc, PA-C; Bruce, Robert Douglas MD, MA, MSc

Author Information
doi: 10.1097/01.JAA.0000488696.73423.02
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Abstract

Providing greater access to HIV screening services has been one of the most successful interventions in reducing the spread of HIV/AIDS.1 The CDC recommends that healthcare providers routinely test every patient for HIV, regardless of their risk.2 However, access to HIV screening remains suboptimal in certain populations and one in seven people living with HIV in the United States are unaware of their infection.3 The primary aims of this quality improvement project were to ensure that the quality of HIV screening services in our clinic met national standards and to monitor our progress over the last 10 years.

METHODS

We present data on HIV testing rates and the demographics of tested patients before and after implementation of universal HIV screening at one federally qualified community health center (CHC).

Data were analyzed from a multisite adult HIV testing program at the Cornell Scott Hill-Health Center in New Haven, Conn., one of the largest and oldest federally qualified CHCs. The deidentified data included age, sex, race, ethnicity, education level, marital status, prior history of HIV testing, health insurance, household income, housing, and risk factors. Data from before and after implementation of universal HIV testing at this CHC in 2008 were compared.

RESULTS

Before the implementation of universal HIV screening at this CHC, 2,526 patients were tested for HIV over a 5-year period from 2003 to 2008 (Table 1). Of the patients tested, 60% were male, 39% were female, and one person was identified as transgender. More than half of those tested were racial and ethnic minorities; 35% were black and 27% were Hispanic. Most patients who were tested (85.5%) were between ages 20 and 49 years. Thirty patients (1.2%) were HIV positive; 80% of these patients were from ethnic minorities (Table 2). HIV was more prevalent in patients ages 30 to 49 years.

T1
TABLE 1.:
Characteristics of patients tested before and after universal HIV screening
T2
TABLE 2.:
Characteristics of HIV-positive patients

Of the 2,526 patients tested, 375 (15%) reported IV drug use in the past year. Only three patients with a history of IV drug use were HIV positive. Most patients who used IV drugs were white men ages 20 to 29 years.

After the implementation of universal HIV screening, 1,684 patients were tested in 1 year (Table 1). Thirty-five percent of the patients who were tested identified themselves as Hispanic, 34% were black, and 21% were non-Hispanic white. Most patients who were tested (72%) were between ages 20 and 49 years. The percentage of patients under age 19 years and those above age 50 years who were tested for HIV in 2013 doubled compared with 2003-2008. In 2013, 12 patients (0.7%)—6 black, 4 Hispanic, and 2 non-Hispanic white—were HIV positive. About 50% of the patients who tested HIV positive were older than age 50 years (Table 2).

CONCLUSION

Before universal HIV screening, significant sex and racial differences in HIV testing existed among patients visiting this CHC. Implementation of universal HIV screening has increased the number of people tested, increased the number of minorities tested, and reduced the HIV testing disparities that previously existed between men and women. Universal HIV screening has the potential to reduce sex and ethnic disparities in HIV screening and prevention. Further studies will address the effect of socioeconomic factors on HIV acquisition and testing among patients at CHCs.

REFERENCES

1. Centers for Disease Control and Prevention. Public Health Service guidelines for counseling and antibody testing to prevent HIV infection and AIDS. MMWR Morb Mortal Wkly Rep. 1987;36(31):509–515.
2. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. J Natl Med Assoc. 2008;100(1):131–147.
3. Bradley H, Hall HI, Wolitski RJ, et al. Vital signs: HIV diagnosis, care, and treatment among persons living with HIV—United States, 2011. MMWR Morb Mortal Wkly Rep. 2014;63(47):1113–1117.
Keywords:

HIV; testing; community health centers; quality improvement; quality improvement project; screening

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