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Sexually Transmitted Infection Testing of HIV-Positive Medicare and Medicaid Enrollees Falls Short of Guidelines

Landovitz, Raphael J. MD, MSc*; Gildner, Jennifer L. MS; Leibowitz, Arleen A. PhD

Sexually Transmitted Diseases: January 2018 - Volume 45 - Issue 1 - p 8–13
doi: 10.1097/OLQ.0000000000000695
Original Studies

Background Men who have sex with men with HIV have high sexually transmitted infection (STI) incidence. Thus, the Centers for Disease Control and Prevention (CDC) recommends at least yearly STI screening of HIV-infected individuals.

Methods We calculated testing rates for syphilis, chlamydia, and gonorrhea among HIV-positive Californians with Medicare or Medicaid insurance in 2010. Logistic regressions estimated how testing for each bacterial STI relates to demographic and provider factors.

Results Fewer than two-thirds of HIV-positive Medicare and fewer than three-quarters of Medicaid enrollees received a syphilis test in 2010. Screenings for chlamydia or gonorrhea were less frequent: approximately 30% of Medicare enrollees were tested for chlamydia or gonorrhea in 2010, but higher proportions of Medicaid enrollees were tested (45%–46%). Only 34% of HIV-positive Medicare enrollees who were tested for syphilis were also screened for chlamydia or gonorrhea on the same day. Nearly half of Medicaid enrollees were tested for all 3 STIs on the same day. Patients whose providers had more HIV experience had higher STI testing rates.

Conclusions Testing rates for chlamydia and gonorrhea infection are low, despite the increase in these infections among people living with HIV and their close association with HIV transmission. Interventions to increase STI testing include the following: prompts in the medical record to routinely conduct syphilis testing on blood drawn for viral load monitoring, opt-out consent for STI testing, and provider education about the clinical importance of STIs among HIV-positive patients. Last, it is crucial to change financial incentives that discourage nucleic acid amplification testing for rectal chlamydia and gonorrhea infections.

Sexually transmitted disease rates are rising rapidly among men who have sex with men, yet sexually transmitted disease screening for people living with HIV is well below the Centers for Disease Control and Prevention recommendations, especially for chlamydia and gonorrhea.

From the *Division of Infectious Diseases, UCLA David Geffen School of Medicine, and UCLA Center for Clinical AIDS Research and Education; and †Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA

This research was supported by grants from the California HIV/AIDS Research Program of the University of California (Grant RP11-LA-020). This work was also supported by the Center for HIV Identification, Prevention, and Treatment (NIMH Grant P30 MH058107-21), the UCLA Center for AIDS Research (Grant 5P30AI028697), and the National Institutes of Health/National Center for Advancing Translational Science (UCLA CTSI Grant No. UL1TR000124). Research was approved by UCLA Institutional Review Board (No. 10-000823).

Conflicts of Interest and Sources of Funding: None declared.

The funders had no role in data collection; management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript for publication.

Correspondence: Arleen A. Leibowitz, PhD, Department of Public Policy, UCLA Luskin School of Public Affairs, Box 951656, 3250 Public Affairs Bldg, Los Angeles, CA 90095-1656. E-mail:

Received for publication May 3, 2017, and accepted July 20, 2017.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

© Copyright 2018 American Sexually Transmitted Diseases Association