Access to HIV testing in healthcare settings increased with implementation of the Affordable Care Act with its requirement for health plan coverage of preventive services, including HIV screening, without patient cost-sharing. We sought to estimate the frequency of HIV testing of males at visits to U.S. physician offices needed to achieve near-universal testing coverage by aged 39 years.
We analyzed data from the 2009-2012 National Ambulatory Medical Care Survey (NAMCS) and the U.S. Census. NAMCS is a nationally representative medical record abstraction of health services provided at physician office visits. We estimated the mean annual number visits by males aged 18-39 years, mean annual visits per person, and HIV testing at visits, stratified by age and race and ethnicity. We calculated the probability of an HIV test in a given year as 1 – (1 – p)r where p = tests / population, and r = visits / population, and modeled the proportion of males who would have been tested by aged 39 years based on current testing rates, and with a 2-, 4-, or 8-fold increase.
Males aged 18-39 years had 58.4 million visits to physician offices, and HIV testing was performed at 754,280 (1.3%) of visits. White males aged 18-24 years had more mean annual visits per person (1.3) than black males (0.61) or Hispanic males (0.59). HIV testing rates were highest for black males aged 18-24 years (2.5% of visits) and 25-29 years (4.2%) and for Hispanic males aged 18-24 years (5.1%) and 25-29 years (2.7%) compared to white males aged 18-24 years (1.1%) and 25-29 years (2.0%). We found that with current testing rates of males aged 18-39 years, 27% of white, 43% of black, and 32% of Hispanic males would be tested at least once for HIV by aged 39 years (Figure); a 2-fold increase in testing would result in coverage of 47% of white, 68% of black, and 54% of Hispanic males; a 4-fold increase in coverage of 73% of white, 91% of black, and 80% of Hispanic males; and an 8-fold increase in coverage of 93% of white, 99% of black, and 97% of Hispanic males.
Increasing HIV testing at visits to U.S. physician offices by 4-fold could achieve high HIV testing coverage by aged 39 years, and by 8-fold could achieve near-universal coverage. Young black and Hispanic males visit physician offices less frequently so increased rates of HIV testing at these visits are needed to achieve optimal testing coverage for this group.