Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Am J Prev Med. 2017 Nov;53(5):634-645. doi: 10.1016/j.amepre.2017.08.006.
HIV testing serves as an entry point for HIV care services for those who test HIV positive, and prevention services for those who test HIV negative. The Centers for Disease Control and Prevention recommends routine testing of adults and adolescents in healthcare settings. To identify missed opportunities for HIV testing at U.S. physicians' offices, data from the National Ambulatory Care Surveys from 2009 to 2012 were analyzed.
The mean annual number and percentage of visits with an HIV test among HIV-uninfected nonpregnant females and males aged 15-65 years was estimated using weighted survey data. Factors associated with HIV testing at visits to physicians' offices were identified.
The mean annual number of U.S. physicians' office visits with an HIV test conducted was 1,396,736 (0.4% of all visits) among nonpregnant females and 986,891 (0.5% of all visits) among males. For both nonpregnant females and males, HIV testing prevalence was highest among those aged 20-29 years (1.3% of all visits by nonpregnant females; 1.7% of all visits by males) and non-Hispanic blacks (1.1% of all visits by nonpregnant females; 1.0% of all visits by males). An HIV test was not conducted at 98.5% of visits at which venipuncture was performed for both nonpregnant females and males.
Important opportunities exist to increase HIV testing coverage at U.S. physicians' offices. Structural interventions, such as routine opt-out testing policies, electronic medical record notifications, and use of non-clinical staff for testing could be implemented to increase HIV testing in these settings.
对于 HIV 检测呈阳性的人，HIV 检测可作为其获得 HIV 护理服务的切入点；对于 HIV 检测呈阴性的人，HIV 检测可作为其获得预防服务的切入点。美国疾病控制与预防中心建议在医疗机构中对成年人和青少年进行常规 HIV 检测。为了确定美国医生办公室在 HIV 检测方面存在的遗漏机会，分析了 2009 年至 2012 年全国门诊医疗调查的数据。
利用加权调查数据，估计了未感染 HIV 的 15-65 岁无妊娠女性和男性每年在医生办公室就诊时接受 HIV 检测的平均次数和百分比。确定了在医生办公室就诊时与 HIV 检测相关的因素。
每年在美国医生办公室进行 HIV 检测的就诊次数为 1396736 次（占所有就诊次数的 0.4%），其中无妊娠女性为 986891 次（占所有就诊次数的 0.5%），男性为 410845 次（占所有就诊次数的 0.5%）。对于无妊娠女性和男性，20-29 岁年龄组的 HIV 检测率最高（占无妊娠女性所有就诊次数的 1.3%；占男性所有就诊次数的 1.7%），而非西班牙裔黑人的 HIV 检测率最高（占无妊娠女性所有就诊次数的 1.1%；占男性所有就诊次数的 1.0%）。对于无妊娠女性和男性，在进行静脉穿刺的就诊中，有 98.5%未进行 HIV 检测。
在美国医生办公室增加 HIV 检测覆盖率的机会很大。可以实施结构性干预措施，如常规选择退出检测政策、电子病历通知以及使用非临床人员进行检测，以增加这些场所的 HIV 检测。
