HIV testing in US emergency departments, outpatient ambulatory medical departments, and physician offices, 1992-2010

In 1993, 2001, and 2006, the US Centers for Disease Control and Prevention (CDC) released revised recommendations aimed to expand HIV screening in health-care settings, increase the number of people who are aware of their infection, improve the health of those who are infected, and reduce HIV transmission. It is unclear how responsive health-care settings have been on a national level to these three successively revised sets of CDC recommendations. This study estimated the extent of HIV testing in US emergency departments (EDs), outpatient ambulatory medical care departments (OPDs), and physician offices among 13- to 64-year-olds from 1992 to 2010 to determine their responsiveness to CDC recommendations to expand HIV testing. The report includes data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Care Survey (NAMCS), which are national probability sample surveys conducted by the National Center for Health Statistics (NCHS) for CDC. Over the entire study period, HIV testing was significantly greater in OPDs than in EDs (p < 0.01) and physician offices (p < 0.01). Multivariable logistic regression analysis showed that Hispanic and Black patients and those receiving Medicaid were more likely to be tested for HIV. Logistic regression tests of trend for the entire study period did not demonstrate significant increases in testing at EDs (Odds ratios [OR] 1.00 [0.97-1.03]) or OPDs (OR 1.01 [0.98-1.04]). For physician offices, there was no change in HIV testing for 1993-1999 (OR 1.03 [0.99-1.06]), but there was a relative increase for the entire study period (OR 1.04 [1.02-1.06]) because of more HIV testing in 2009 and 2010 in this setting. However, there were no differences in HIV testing for each setting for the interval years after revised CDC HIV testing recommendations were released for 1993-2001, 2002-2006, and 2007-2010.