Assessing Gaps in Integrated HIV and STI Testing Among New York State-Funded Providers by Pre-exposure Prophylaxis...

Area of Science:

• Public Health
• Infectious Disease Prevention
• Health Services Research

Background:

• High rates of untested individuals for HIV in the US, with nearly two-thirds of adults never tested.
• Integrated HIV and sexually transmitted infection (STI) testing is recommended as a status-neutral prevention strategy.

Purpose of the Study:

• To evaluate the implementation and disparities in integrated HIV and STI testing in New York State primary care settings.
• To assess factors influencing the completion of integrated testing events within 30 days.

Main Methods:

• Analysis of weekly testing data from December 2022 to January 2024 across over 200 diverse healthcare settings.
• Prospective evaluation of integrated testing completion and assessment of group differences by demographics, risk, and pre-exposure prophylaxis (PrEP) status.
• Statistical analysis using Pearson chi-squared tests and log binomial models stratified by PrEP usage.

Main Results:

• Integrated testing was completed by 69% of individuals on PrEP versus 39% not on PrEP (P < 0.001).
• Significant disparities in integrated screening were observed across sex at birth, gender, race/ethnicity, and risk factors, with similar patterns by PrEP status.
• Lower integrated screening rates were noted for individuals identifying as female at birth, non-Hispanic Black, those without elevated risk, and in non-hospital settings.
• HIV and STI test reactivity rates were lower among integrated testers compared to those receiving single-infection tests.

Conclusions:

• A significant gap exists in integrated HIV and STI testing implementation, leading to missed opportunities for diagnosis.
• System-level integration requires addressing perceived individual and provider risks and benefits of testing.
• Improving integrated testing uptake is crucial for enhancing HIV and STI prevention and early detection efforts.