VA Office of Rural Health, Veterans Rural Health Resource Center-Central Region, Iowa City VAMC, Iowa City, IA, USA.
BMC Public Health. 2011 Sep 1;11:681. doi: 10.1186/1471-2458-11-681.
Studies in the United States show that rural persons with HIV are more likely than their urban counterparts to be diagnosed at a late stage of infection, suggesting missed opportunities for HIV testing in rural areas. To inform discussion of HIV testing policies in rural areas, we generated nationally representative, population-based estimates of HIV testing frequencies in urban vs. rural areas of the United States.
Secondary analysis of 2005 and 2009 Behavioral Risk Factor Surveillance System (BRFSS) data. Dependent variables were self-reported lifetime and past-year HIV testing. Urban vs. rural residence was determined using the metropolitan area framework and Urban Influence Codes and was categorized as 1) metropolitan, center city (the most urban); 2) metropolitan, other; 3) non-metropolitan, adjacent to metropolitan; 4) non-metropolitan, micropolitan; and 4) remote, non-metropolitan (the most rural).
The 2005 sample included 257,895 respondents. Lifetime HIV testing frequencies ranged from 43.6% among persons residing in the most urban areas to 32.2% among persons in the most rural areas (P < 0.001). Past-year testing frequencies ranged from 13.5% to 7.3% in these groups (P < 0.001). After adjusting for demographics (age, sex, race/ethnicity, and region of residence) and self-reported HIV risk factors, persons in the most remote rural areas were substantially less likely than persons in the most urban areas to report HIV testing in the past year (odds ratio 0.65, 95% CI 0.57-0.75). Testing rates in urban and rural areas did not change substantively following the 2006 Centers for Disease Control and Prevention recommendation for routine, population-based HIV testing in healthcare settings. In metropolitan (urban) areas, 11.5% (95% CI 11.2-11.8) reported past-year HIV testing in 2005 vs. 11.4% (95% CI 11.1%-11.7%) in 2009 (P = 0.93). In non-metropolitan areas, 8.7% (95% CI 8.2%-9.2%) were tested in 2005 vs. 7.7% (95% CI 7.2%-8.2%) in 2009 (P = 0.03).
Rural persons are less likely than urban to report prior HIV testing, which may contribute to later HIV diagnosis in rural areas. There is need to consider strategies to increase HIV testing in rural areas.
美国的研究表明，与城市相比，农村地区的艾滋病毒感染者更有可能在感染晚期被诊断出来，这表明农村地区错过了艾滋病毒检测的机会。为了为农村地区的艾滋病毒检测政策提供信息，我们生成了全国代表性的城市与农村地区艾滋病毒检测频率的人口基数估计值。
对 2005 年和 2009 年行为风险因素监测系统（BRFSS）数据进行二次分析。依赖变量为自我报告的终身和过去一年的艾滋病毒检测。城市与农村居住的划分依据是大都市区框架和城市影响力代码，并分为 1）大都市区，中心城市（最城市化）；2）大都市区，其他地区；3）非大都市区，毗邻大都市区；4）非大都市区，小城市；和 4）偏远，非大都市区（最农村化）。
2005 年的样本包括 257895 名受访者。终身艾滋病毒检测频率从居住在最城市化地区的人的 43.6%到居住在最农村地区的人的 32.2%不等（P<0.001）。在这些群体中，过去一年的检测频率范围从 13.5%到 7.3%不等（P<0.001）。在调整人口统计学因素（年龄、性别、种族/族裔和居住地区域）和自我报告的艾滋病毒风险因素后，处于最偏远农村地区的人报告过去一年接受艾滋病毒检测的可能性明显低于处于最城市化地区的人（比值比 0.65，95%置信区间 0.57-0.75）。在 2006 年疾病控制和预防中心建议在医疗保健环境中常规进行基于人群的艾滋病毒检测后，城市和农村地区的检测率并没有实质性变化。在大都市（城市）地区，2005 年有 11.5%（95%置信区间 11.2-11.8）报告过去一年接受了艾滋病毒检测，而 2009 年有 11.4%（95%置信区间 11.1%-11.7%）（P=0.93）。在非大都市地区，2005 年有 8.7%（95%置信区间 8.2%-9.2%）接受了检测，而 2009 年有 7.7%（95%置信区间 7.2%-8.2%）（P=0.03）。
与城市相比，农村地区的人更不可能报告以前的艾滋病毒检测情况，这可能导致农村地区的艾滋病毒诊断较晚。有必要考虑在农村地区增加艾滋病毒检测的策略。
