HIV Testing Rates Remain Low Despite CDC Recommendations

HIV testing must increase at least 3-fold in order to achieve the 2025 benchmark of ≥ 95% of persons in the United States knowing their serostatus, as set forth by the Ending the HIV Epidemic initiative, and to reduce care disparities that continue to impact HIV diagnoses, according to the CDC’s latest Morbidity and Mortality Weekly Report.

Although higher rates of HIV testing were seen among males and nonpregnant females 13 years and older from 2014 to 2019 who had either commercial insurance or Medicaid coverage, the total percentages still came in below 6.0% each year, at just 4.0% for commercially insured persons and 5.5% for those with Medicaid coverage. Gaps in overall testing were also seen in that persons with Medicaid got tested more for HIV, as did Black/African American and Hispanic/Latino persons vs commercially insured and White individuals, respectively.

“Recent studies show low HIV testing rates in clinical settings; HIV testing rates at visits to physician offices did not increase during 2009-2016,” the authors wrote. “The objective of the current study is to estimate temporal trends in HIV testing among persons with commercial insurance or Medicaid from 2014 through 2019 and describe their demographic characteristics in 2019.”

For the analysis, the authors used 2014-2019 data from the IBM MarketScan Commercial Claims and Encounters database (commercial insurance; covers close to 40 million each year) and the CMS claims database (Medicaid; contains data on all states and the District of Columbia). “Race/ethnicity data were available only for persons with Medicaid, therefore the trend in testing over time was estimated by race/ethnicity only for those with Medicaid,” the authors noted.

Their breakdown by year produced these results:

• For commercially insured individuals, HIV testing rates never rose above 4.0%: 3.1% in 2014; 3.0% in 2015 and 2016, 3.3% in 2017, 3.7% in 2018, and 4.0% in 2019
• For persons with Medicaid coverage, HIV testing rates never rose above 5.5%: 5.0% in 2014, 4.6% in 2015, 4.9% in 2016, 5.2% in 2017, 5.4% in 2018, and 5.5% in 2019
• Looking at Medicaid coverage, testing rates rose among 4 of the 5 groups for whom racial/ethnic data were available (Whites, Blacks/African Americans, Asian, Other); testing among Hispanic/Latinos dropped slightly

Looking at age group, the highest testing rates were seen among persons aged 19-29 years in both groups (6.8%, commercially insured; 8.5%, Medicaid); the lowest testing rates were seen among persons aged 13 to 14 years with commercial insurance and 65 years and older with Medicaid coverage. In addition, when considering race/ethnicity, the highest testing rates were seen among Blacks/African Americans, at 8.5%, and the lowest were seen among Whites, at 3.9%.

For residence and US Census region, respectively, most HIV tests were performed among urban commercially insured and Medicaid beneficiaries with “unknown” residence location and among individuals who lived in the Northeast (both groups). The lowest testing rates were seen among rural residents in both groups and those who lived in the Midwest (commercial) and South (Medicaid).

“HIV testing is a critical component of effective HIV prevention and care,” the authors wrote. “CDC recommends routine opt-out HIV testing in health care settings for all sexually active persons aged 13-64 years at least once in their lifetime and risk-based testing regardless of age for those who report behaviors associated with HIV acquisition.”

Public health and hospital systems should collaborate on implementing interventions that incorporate “clinical decision support tools in electronic health records to generate automated orders for routine opt-out testing or risk-based testing,” they concluded.

Reference

Henny KD, Zhu W, Huang Y-AA, Townes A, Delaney KP, Hoover KW. HIV Testing Trends Among Persons with Commercial Insurance or Medicaid — United States, 2014–2019. MMWR Morb Mortal Wkly Rep. 2021;70(25):905-909. doi:10.15585/mmwr.mm7025a1