Utilization Trends: HIV Testing Among Vulnerable Populations Remains Disturbingly Low, Says CDC

Identifying patients who are unaware of their positive HIV status and linking them to care is crucial to reducing HIV infection, particularly among sexually active teens and young adults remains low. But a troubling new U.S. Centers for Disease Control and Prevention (CDC) report indicates that testing rates for these vulnerable populations remain behind stated U.S. goals.

The CDC Findings
The June 23 report is contained in the CDC's Division of HIV/AIDS Prevention in Morbidity and Mortality Weekly Report (MMWR). The report includes analysis of CDC-funded program data for youths submitted by 61 health departments (state and local) and 123 community-based organizations that provided HIV testing and related services in 2015.

In 2015, more than 3 million CDC-funded tests were run with 28 percent provided to youths—primarily ages 20–24 years (74 percent), female (55 percent), and black (50 percent). More than three-quarter of tests were provided in health care facilities and in medium and high prevalence areas (97 percent). Tests in health care facilities were less likely to yield new diagnoses than tests performed in non-health care facilities, the report finds.

An average of 22 percent of high school students who had sexual intercourse and 33 percent of young adults (ages 18 to 24) reported ever receiving an HIV test. Among the nearly 4,900 HIV infections identified among youths, 39 percent had been previously diagnosed, but 92 percent of those youths with previously diagnosed infection were not in HIV medical care at the time of testing. Young men who have sex with men accounted for 83 percent of new diagnoses among all youths in non-health care facilities and received 28 percent of HIV tests in those settings.

Recommendations for Increasing HIV Testing
"Increasing the number of youths at risk for HIV infection who are tested for HIV on a regular basis and ensuring that youths who receive positive test results for HIV are rapidly linked to and retained in appropriate medical care, including early initiation of antiretroviral therapy, are essential steps for reducing HIV infection in this vulnerable population," writes Renee Stein, Ph.D., in the report. "Including HIV testing as part of routine medical care for youths is key to increasing early diagnosis, and a health care provider's testing recommendation is the most important predictor of testing among adolescents at risk for HIV infection."

The CDC suggests that the necessary increased testing could be accomplished via a combined strategy of routine HIV testing among youths, especially young men, in health care settings, and targeted testing in settings where youths at risk for HIV infection congregate. Additionally, the CDC calls for measures to encourage health care providers to include HIV testing as a routine part of health care for youth and suggests schools can also play an important role in facilitating access to HIV testing.

Takeaway: Strategies are needed to increase HIV testing among young adults, including measures to make HIV testing routine in the health care setting and expand nontraditional settings where at-risk youth may congregate.