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Health Workers Not Following CDC Advice on Testing Older Adults for HIV
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20th International AIDS Conference, July 20-25, 2014, Melbourne
Mark Mascolini
Rates of HIV testing among older US adults fell after the Centers for Disease Control and Prevention (CDC) recommended opt-out HIV testing for all adults up to age 64 whenever they seek medical care [1]. But HIV testing rose significantly among older black adults in the United States after CDC advice came out.
Collaborators from the University of California and the National Institute of Alcoholism and Alcohol Abuse noted that routine HIV testing is "particularly important" in older adults because many older people and their clinicians believe they run a low risk of HIV infection even though HIV prevalence and the size of the risk pool are growing among older adults. To see whether HIV testing rates in older adults--defined here as 50 to 64 years old--have changed since the CDC issued its guidance in September 2006 [2], these investigators analyzed data from the CDC's US Behavioral Risk Factor Surveillance System (BRFSS) from 2003 through 2010.
The study included 899,965 US residents 50 to 64 years old who completed a BRFSS interview between January 1, 2003 and December 31, 2010. The study sample is representative of the US population and of each state's population. The main variable analyzed was whether people had an HIV test in the past 12 months. The investigators divided participants into two groups: 2003-2006 (before the new CDC testing recommendations) and 2007-2010 (after the new recommendations).
The study group had similar proportions of people 50 to 54 (34.5%), 55 to 59 (34.1%) and 60 to 64 (31.3%). HIV testing rates across the three age groups fell from 5.5% in 2003 to 3.6% in 2006 (beta = -0.16), then rose in 2007, only to fall back to 3.7% in 2010.
Weighted HIV testing prevalence for men and women in each of the three age groups never exceeded 7%. Among men the overall testing rate fell from 6.1% in 2003-2006 to 5.4% in 2007-2010, a significant drop (P < 0.001). Among women the HIV testing rate was similar in 2003-2006 (3.1%) and 2007-2010 (3.0%) (P = 0.3944). Among both men and women, testing rates fell in each successively older age group in both 2003-2006 and 2007-2010.
Multiple logistic regression determined that the overall linear annual trend in recent HIV testing for 2003-2010 was -0.16 (95% confidence interval [CI] -0.21 to -0.12, P = 0.000). The linear annual trend for recent HIV testing by age was -0.05 (95% CI -0.05 to -0.04, P = 0.000).
Weighted HIV testing prevalence among whites dwindled from 3.5% in 2003-2006 to 2.9% in 2007-2010 (P < 0.001). Among Asians the testing rate fell from 4.1% to 2.1% from the early period to the late period (P = 0.0086). But among blacks the testing rate climbed from 10.4% in 2003-2006 to 11.6% in 2007-2010, a significant gain (P = 0.0245). Multivariate logistic regression analysis determined that blacks were the only racial/ethnic group whose testing rates rose over time (odds ratio 1.20, 95% CI 1.14 to 1.26, P = 0.000). Testing rates did not change significantly from one period to the next among Hispanics, Pacific Islanders, or American Indians/Alaska Natives.
Weighted HIV testing prevalence did not change from 2003-2006 to 2007-2010 for single people, but it dropped significantly among married or cohabitating people (from 3.6% in 2003-2006 to 3.2% in 2007-2010, P < 0.001).
The testing rate fell significantly from one period to the next among people who have a usual source of care (4.6% to 4.2%, P < 0.001). Testing rates were slightly higher in hospitals than clinics in both periods, but the rate dropped significantly from the early to the late period both in clinics (19.5% to 16.5%, P < 0.001) and hospitals (21.0% to 17.6%, P < 0.001).
The researchers concluded that CDC testing recommendations "may not be implemented widely among US older adults, except among blacks, a group heavily targeted during this period." They suggested that programs addressing HIV testing "implementation barriers" may yield higher testing rates among older adults.
References
1. Ford C, Godette D, Gaines T. Recent HIV testing among U.S. older adults since and prior to release of CDC's routine HIV testing recommendations: national findings based on the behavioral risk factor surveillance system (BRFSS). AIDS 2014. 20th International AIDS Conference. July 20-25, 2014. Melbourne. Abstract WEPE155.
2. Branson BM, Handsfield, HH, Lampe MA, et al. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. MMWR Morbidity and Mortality Weekly Report. 2006;55(RR14):1-17. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm
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