Both the US Preventive Services Task Force and the Centers for Disease Control and Prevention recommend routine, voluntary, “opt-out” HIV testing for all adolescents and adults. Despite these recommendations, HIV testing is not routine practice. Furthermore, integrated HIV, STI, and hepatitis testing is even less common.
We analyzed outpatient HIV, STI, and viral hepatitis-related insurance claims from the Oregon All Payers All Claims Database (APAC) for 2016. Using ICD-10 and CPT codes, we identified the number of patients that had an HIV test, an STI test, and a hepatitis B or hepatits C test. We excluded those aged <13 years and >64 years, pregnant women, and those previously diagnosed with HIV. We examined demographic, healthcare, and geographic predictors of HIV testing and integrated HIV, STI and hepatitis testing.
In 2016, 4.8% of the sample (n=1,780,612) had an HIV test, 13.0% had a test for an STI or hepatitis B or C,and 4.2% had integrated HIV and STI or hepatitis testing. At visits that included an HIV test, 88.3% were tested for an STI or hepatitis. Conversely, at visits that included an STI or hepatitis test, 31.5% were tested for HIV. HIV tests were most commonly accompanied by gonorrhea/chlamydia (62.4%), syphilis (53.0%), and hepatitis B (47.2%) testing. Women were more likely to be tested for HIV and experience integrated testing than men. Those aged 18-29 were most likely to have an HIV test and HIV/STI/hepatitis co-testing, while those aged 50-64 were least likely to be tested. Black/African Americans were most likely to be tested for HIV and to have integrated testing while Native American/Alaska Natives were least likely to experience these testing services. Compared to those with other insurance coverage, those with Medicaid were more than two times more likely to be tested for HIV and to have integrated testing. Those in rural and frontier regions were less likely to be tested for HIV and STI/hepatitis than those in urban areas.
Routine HIV testing and integrated HIV/STI/hepatitis testing are not widespread practice. Routine, rather than risk-based, testing, is critical to the timely diagnosis and treatment and, thus, prevention of onward HIV, STI, and hepatitis transmission.