Monitoring HIV Testing at Visits to Emergency Departments in the United States: Very-Low Rate of HIV Testing

Background: Early diagnosis and treatment of HIV infection result in improved clinical outcomes and decreased transmission, yet many infected persons are unaware of their infection or are diagnosed late. The Centers for Disease Control and Prevention recommends routine opt-out testing of all persons aged 13-64 years in high prevalence settings. Study Objective: To describe methods to estimate HIV testing rates at visits to emergency departments (EDs) for monitoring adherence to recommendations for opt-out testing. Methods: We analyzed data from the 2009 National Hospital Ambulatory Medical Care Survey. In 2009, 2 questions were added to the survey about HIV status and testing. We estimated the frequency of HIV testing at ED visits made by persons aged 13-64 years not known to be HIV infected. Results: In 2009, 90.5 million visits were made to EDs, including 60.0% by whites, 24.5% by blacks, and 12.1% by Hispanics and 38.4% by privately insured, 25.7% by Medicaid insured, and 21.4% by uninsured persons. Among 89.9 million visits by patients not known to be HIV infected, HIV testing was performed at only 0.2% of visits. Among 3.4 million visits made by persons in whom targeted testing is recommended-those with increased risk for HIV and other sexually transmitted diseases or pregnancy-only 2.3% were tested for HIV. Conclusions: National Hospital Ambulatory Medical Care Survey can be a useful tool to monitor trends in HIV testing in US EDs. A high proportion of visits to EDs in the United States were made by uninsured and Medicaid insured persons, and routine HIV testing was a rare event during ED visits.