Newton-Dame Remle, Wang Jason J, Kim Michelle S, Edelstein Zoe R, Cutler Blayne, Tsoi Benjamin W
*Primary Care Information Project; and †Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, Queens, NY.
J Acquir Immune Defic Syndr. 2015 Jan 1;68 Suppl 1:S15-20. doi: 10.1097/QAI.0000000000000407.
In 2010, the New York State Legislature made it mandatory to offer an HIV test to people aged 13-64 years receiving hospital or primary care services, with limited exceptions. In this study, we used data from New York City practices to evaluate the impact of the law on HIV testing rates in ambulatory care.
We collected quarterly testing data from the electronic health records of 218 practices. We calculated overall and stratified crude testing rates. Using univariate and multivariate generalized estimating equation models, we assessed the odds of testing in the year before the law (baseline) versus the first and second year after the law's implementation (year 1 and year 2).
During baseline, the odds of testing did not increase significantly. During year 1, the odds of testing significantly increased by 50% in the univariate model and 200% after adjusting for confounders. During year 2, the odds of testing increased 10%. This was only significant in the univariate model. The crude quarterly testing rate increased from 2.8% to 5.7% from baseline to year 2.
Our evaluation showed that after the implementation of the HIV testing law, there was an increase in HIV testing among NYC ambulatory practices. Testing rates remained modest, but considerable improvement was seen in community health centers, in age ranges targeted by the law and in practices that were screening for HIV at baseline. This study suggests that legislation may be effective when used in a comprehensive prevention strategy.
2010年，纽约州立法机构规定，除有限的例外情况外，必须为年龄在13至64岁且接受医院或初级保健服务的人群提供艾滋病毒检测。在本研究中，我们使用来自纽约市医疗机构的数据来评估该法律对门诊护理中艾滋病毒检测率的影响。
我们从218家医疗机构的电子健康记录中收集了季度检测数据。我们计算了总体和分层的粗检测率。使用单变量和多变量广义估计方程模型，我们评估了法律实施前一年（基线）与法律实施后第一年和第二年（第1年和第2年）的检测几率。
在基线期间，检测几率没有显著增加。在第1年，单变量模型中检测几率显著增加了50%，在调整混杂因素后增加了200%。在第2年，检测几率增加了10%。这仅在单变量模型中显著。从基线到第2年，粗季度检测率从2.8%提高到了5.7%。
我们的评估表明，艾滋病毒检测法律实施后，纽约市门诊医疗机构的艾滋病毒检测有所增加。检测率仍然较低，但在社区卫生中心、法律针对的年龄范围以及基线时进行艾滋病毒筛查的医疗机构中，有了相当大的改善。这项研究表明，立法在全面预防策略中使用时可能是有效的。
