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Routine HIV testing missed opportunities in a safety-net system. Most diagnosed individuals had no prior HIV test, indicating a need to improve opt-out testing, especially in primary care.

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Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Healthcare Systems Research

Background:

  • Routine, opt-out HIV testing aims for earlier diagnosis and reduced transmission.
  • This study investigates missed opportunities (MO) and missed testing opportunities (MTO) within such a strategy in a safety-net healthcare system.

Purpose of the Study:

  • To identify factors associated with missed opportunities for earlier HIV diagnosis.
  • To evaluate the effectiveness of a routine opt-out HIV testing program.

Main Methods:

  • Retrospective analysis of adults diagnosed with HIV between 2015-2022.
  • Defined MO as no HIV test in the year prior to diagnosis; MTO as indicated but unperformed tests.
  • Used logistic regression to identify factors associated with MO and MTO.

Main Results:

  • 70% of newly diagnosed individuals had MO; 67% of encounters were MTO.
  • Sexual health and STI testing encounters showed lower MO odds.
  • Primary care encounters had higher MTO odds compared to emergency departments.
  • Only 37.4% of eligible individuals received HIV testing, with a 0.4% diagnosis rate.

Conclusions:

  • Despite opt-out HIV testing, significant missed opportunities for early diagnosis persist.
  • Optimizing opt-out testing procedures is crucial, particularly in primary care settings and during non-sexual health visits.