Missed Opportunities to Test, Diagnose HIV Found Across US

Cyprian Wejnert, PhD

Researchers at the US Centers for Disease Control and Prevention (CDC) using surveillance data from 19 US cities found that a substantial number of persons unaware of their HIV infection report missed opportunities for being tested and diagnosed in earlier visits with clinicians.

Cyprian Wejnert, PhD, Epidemiologist, Division of HIV/AID Prevention, CDC, Atlanta, Georgia, and colleagues emphasize that many HIV infections detected among 2 high-risk groups, men who have sex with men (MSM) and persons who inject drugs (PWID), could have been diagnosed sooner if HIV testing were offered during their clinical visits.

"Clinicians who have a routine way to assess sexual risk are more likely to offer HIV testing," Wejnert told MD Magazine®. "However, barriers to testing, including stigma, remain. We need to make the process easier."

The researchers accessed the CDC's National HIV Behavioral Surveillance (NHBS), which collects biobehavioral data from high-risk populations in rotating annual cycles in US cities with high HIV prevalence. Their report is based on a total sample of over 28,000 adults ≥18 years old in 19 cities. Data from MSM were collected in 2014 and from PWID in 2012 and 2015.

Persons were defined as having been unaware of their confirmed HIV infection if they had reported not receiving HIV testing or positive test result and had no detectable antiretroviral drugs in a blood sample. In addition to whether they had been tested for HIV in the past year, they were asked if they had visited a clinician—characterized as either a doctor, nurse, or other health care provider—and if the clinician had offered HIV testing.

The researchers determined that 22% of MSM and 8% of PWID had a positive HIV test, and of those, 8% of MSM and 12% of PWID had been unaware of their infection. Among those unaware of their confirmed infection, 81% of MSM and 65% of PWID reported having visited a clinician in the past year; and 43% of MSM and 24% of PWID reported being offered an HIV test in that clinical visit.

"Approximately half of unaware MSM and PWID who reported not having been tested in the past year reported not being offered HIV testing by any clinician despite having seen one," the researchers indicated.

Wejnert discussed measures which could be undertaken to reduce these "missed opportunities" with MD Mag.

"Certain structural interventions, such as integrating HIV testing into testing for other diseases, such as other sexually transmitted diseases, or adding automated electronic medical record prompts for HIV testing for people at high risk or those with no history of testing, make HIV screening easier for clinicians, while removing stigma by making HIV testing more routine," Wejnert said.

"The most effective strategies will be those that increase testing without placing additional demands on clinicians or patients," he added.

The report, Prevalence of Missed Opportunities for HIV Testing Among Persons Unaware of Their Infection, was published in JAMA.