Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States of America.
Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America.
PLoS One. 2022 Jul 14;17(7):e0266747. doi: 10.1371/journal.pone.0266747. eCollection 2022.
Men who have sex with men (MSM) account for most new HIV diagnoses in the US. Annual HIV testing is recommended for sexually active MSM if HIV status is negative or unknown. Our primary study aim was to determine annual HIV screening rates in primary care across multiple years for HIV-negative MSM to estimate compliance with guidelines. A secondary exploratory endpoint was to document rates for non-MSM in primary care.
We conducted a three-year retrospective cohort study, analyzing data from electronic medical records of HIV-negative men aged 18 to 45 years in primary care at a large academic health system using inferential and logistic regression modeling.
Of 17,841 men, 730 (4.1%) indicated that they had a male partner during the study period. MSM were screened at higher rates annually than non-MSM (about 38% vs. 9%, p<0.001). Younger patients (p-value<0.001) and patients with an internal medicine primary care provider (p-value<0.001) were more likely to have an HIV test ordered in both groups. For all categories of race and self-reported illegal drug use, MSM patients had higher odds of HIV test orders than non-MSM patients. Race and drug use did not have a significant effect on HIV orders in the MSM group. Among non-MSM, Black patients had higher odds of being tested than both White and Asian patients regardless of drug use.
While MSM are screened for HIV at higher rates than non-MSM, overall screening rates remain lower than desired, particularly for older patients and patients with a family medicine or pediatric PCP. Targeted interventions to improve HIV screening rates for MSM in primary care are discussed.
男男性行为者（MSM）占美国新诊断出的 HIV 病例的大多数。如果 HIV 检测结果为阴性或未知，建议活跃的 MSM 每年进行 HIV 检测。我们的主要研究目的是确定在多年内，对 HIV 阴性 MSM 进行年度 HIV 筛查的比率，以评估其对指南的遵守情况。次要的探索性终点是记录初级保健中非 MSM 的比率。
我们进行了一项为期三年的回顾性队列研究，使用推断和逻辑回归模型分析了来自大型学术健康系统中，年龄在 18 至 45 岁之间的 HIV 阴性男性的电子病历数据。
在 17841 名男性中，有 730 名（4.1%）表示在研究期间有男性伴侣。与非 MSM 相比，MSM 每年接受筛查的比例更高（约 38%比 9%，p<0.001）。年轻患者（p 值<0.001）和内科初级保健提供者的患者（p 值<0.001）在两组中更有可能接受 HIV 检测。对于所有种族和自我报告的非法药物使用类别，MSM 患者接受 HIV 检测的可能性都高于非 MSM 患者。在 MSM 组中，种族和药物使用对 HIV 检测的影响并不显著。在非 MSM 患者中，无论是否使用药物，黑人患者接受检测的可能性都高于白人患者和亚洲患者。
尽管 MSM 接受 HIV 检测的比例高于非 MSM，但总体检测率仍低于预期，尤其是对于老年患者和家庭医学或儿科初级保健提供者的患者。讨论了在初级保健中提高 MSM HIV 检测率的针对性干预措施。
