Few Young Males Opt for HIV Testing During Visits to Physicians

CDC finds need for interventions to improve HIV testing rates among men between 15- and 39-years-old.

A new study found that males 15- to 39-years-old had an average of 1.35 annual visits to physicians, with fewer than 1.1% of these visits including an HIV test.

In 2014, 81% of HIV diagnoses in the United States were in males, with the highest number of cases reported in men between 20- and 29-years-old.

To analyze this issue, the US Centers for Disease Control and Prevention (CDC) evaluated data from the 2009-2012 National Ambulatory Medical Care Survey (NAMCS) and US Census data to estimate the rates of health care use at physicians’ offices with HIV testing performed during these encounters.

HIV infection was defined using International Classification of Diseases, Ninth Revision (ICD-9) codes and Reason for Visit codes consistent with HIV infection. In the NAMCS, a 4-stage probability sampling design was used to generate nationally representative weighted estimates of patient health care visits.

For the NAMCS, physicians were selected and randomly assigned a 1-week data reporting period. To be eligible for the survey, physicians had to be engaged in office-based patient care, principally engaged in patient care activities, not federally employed, and not in the specialties of radiology, anesthesiology, and pathology.

Data collectors abstracted medical records from a systematic random sample of patient visits. The data collected included symptoms, diagnoses, prescribed medications, provided services, and demographic characteristics.

The results of the CDC study showed that white males visited physicians more often, with an average annual rate of 1.6 visits per person, compared with 0.9 visits per person in black males and 0.8 visits per person in Hispanic males.

Overall, an HIV test was performed at 674,001 (1.0%) of visits to physicians by young males, 15- to 39-years-old. There were higher testing rates among black males (2.7%) and Hispanic males (1.4%) compared with white males (0.7%).

Researchers noted that, although there was a higher proportion of black and Hispanic males who received HIV testing compared with white males, it was most likely because of the lower rate of health care visits.

Compared with rates among males who were between 35- and 39-years-old (0.6%), HIV testing rates were higher in males aged 20- to 24-years-old (1.7%) (PR = 3.0; p=0.007) and 25- to 29-years-old (1.8%) (PR= 3.1; p=0.002). Along with the age bracket of 35- to 39-years-old (0.6%), the HIV testing rate was lowest among males between 15- and 19-years-old (0.6%) (PR= 1.0; p=0.997).

Interventions to routinize HIV testing at physicians’ offices could be implemented to improve HIV testing coverage, according to researchers.

Three limitations to the study were that nonresponses to an invite to participate in NAMCS might have resulted in underestimation or overestimation of HIV testing; the small sample sizes in NAMCS allow only limited subgroup analyses of HIV testing; and behavioral risk factors such as injection drug use or sexual behavior were unavailable in NAMCS.

The authors noted that a systems-level approach to increase HIV testing rates could use interventions to help routinize HIV testing, such as provider education campaigns, electronic medical record reminders, opt-out testing policies, and removing barriers to testing, such as special consent forms.

Through these interventions, it may help the increase rates of young men who receive HIV testing at their physicians’ office appointments, the study concluded.