HIV test rate remains low despite CDC recommendations

HIV Need more tests at least To achieve the 2025 benchmark of knowing serum status and reduce the disparity in care that continues to affect HIV diagnosis, as defined by the HIV Epidemic Eradication Initiative for more than 95% of people in the United States It will be tripled. CDC latest Weekly morbidity and mortality reports..

From 2014 to 2019, the proportion of HIV tests was high among men over the age of 13 and non-pregnant women who received either commercial insurance or Medicaid, but the total proportion remains at 6.0% annually. Below, only 4.0% for commercial insureds. 5.5% of people are eligible for Medicaid. The overall test gap is also seen in that Medicaids were tested more for HIV, as were blacks / African Americans, Hispanics / Latinos, commercial insurers, and whites, respectively. was.

“Recent studies have shown low rates of HIV testing in clinical settings. HIV testing rates during clinic visits did not increase between 2009 and 2016,” the authors wrote. There is. “The purpose of the current study is to estimate the temporal trend of HIV testing in patients with commercial insurance or Medicaid from 2014 to 2019 and to explain the demographic characteristics of 2019.”

The analysis includes the IBM MarketScan Commercial Claims and Encounters database (commercial insurance, covering nearly 40 million cases annually) and the CMS claims database (Medicaid, which includes data for all states and Districts of Columbia) 2014-2019. Data was used. ). “Race / ethnic data was only available to those who had Medicaid, so trends in testing over time were estimated by race / ethnicity only to those who have Medicaid,” the author said. It was.

The yearly breakdown yielded the following results:

• For commercially insured individuals, the HIV test rate never exceeded 4.0%. 3.0% in 2015 and 2016, 3.3% in 2017, 3.7% in 2018, 4.0% in 2019
• For Medicaid subjects, HIV testing rates did not exceed 5.5%: 5.0% in 2014, 4.6% in 2015, 4.9% in 2016, 5.2% in 2017, 5.4% in 2018 , 5.5% in 2019
• Looking at Medicaid coverage, test rates increased in four of the five groups for which racial / ethnic data were available (whites, blacks / African Americans, Asians, and others).Tests between Hispanic / Latin Americans failed slightly

Looking at the age group, both groups had the highest test rates among people aged 19-29 years (6.8%, commercial insurance, 8.5%, Medicaid). The lowest test rates were found in people aged 13-14 with commercial insurance and those aged 65 and over with Medicaid. In addition, considering race / ethnicity, the highest test rate was 8.5% for Black / African Americans and the lowest was 3.9% for Caucasians.

In residential and US census areas, most HIV tests were conducted on beneficiaries of commercial insurance and Medicaid in cities where they lived “unknown”, and individuals (both groups) living in the northeast. The lowest test rates were found between both groups of rural residents and those who lived in the Midwest (commercial) and southern (Medicade).

“HIV testing is an important element of effective HIV prevention and care,” the author writes. “The CDC reports to people who report behaviors associated with HIV infection, at least once in their lifetime, at least once in their lifetime, on a regular basis in the medical setting of all sexually active persons aged 13-64 years. We recommend opt-out HIV testing and risk-based testing. “

Public health and hospital systems need to help implement interventions that “incorporate clinical decision support tools into electronic health records to generate automated orders for regular opt-out or risk-based tests.” Concluded.

reference

Henny KD, Zhu W, Huang Y-AA, Townes A, Delaney KP, Hoover KW Trends in HIV testing for people with commercial insurance or Medicaid — USA, 2014-2019. MMWR Morb Mortal Wkly Rep. 2021; 70 (25): 905-909. doi: 10.15585 / mmwr.mm7025a1