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Bradley C. Fetzer M.D. M.P.H., Florence Momplaisir, M.D. M.S.H.P., Judith A. Long M.D.. HIV testing rates fall well below...
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Comparison of HIV Testing with other Markers of Chronic Disease Screening 4_24_13 Judith Long


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Comparison of HIV Testing with other Markers of Chronic Disease Screening 4_24_13 Judith Long

  1. 1. Bradley C. Fetzer M.D. M.P.H., Florence Momplaisir, M.D. M.S.H.P., Judith A. Long M.D.. HIV testing rates fall well below ratesof other chronic disease screening inthis cohort. Populations whose primary source ofcare lies in community healthclinics, emergency rooms, or reportnone or ‘other’ non-private sourcesof care are more likely to receive HIVtesting compared with traditionalprivate clinics. While community health clinics arecomparable to private clinics in ratesof routine chronic diseasescreening, not surprisingly thosewho report the ED or none or ‘other’as their primary source of care areless likely to receive routine chronicdisease screening. Primary Care Physicians: Adhere well to screeningguidelines for blood pressure andcancer screening. May neglect appropriatelyscreening their populations forHIV.ConclusionsBackground Data: 2002-2010 Southeastern Pennsylvania (SEPA) Household survey, which is the largest andmost comprehensive health survey in Pennsylvania. It is administered every two years andevaluates the health status and health care experiences of adults living in the region. Weighted survey data used to compare:Number of people ever tested for HIV and tested within the prior year.Number of people who reported age and sex appropriate chronic disease screening:• Blood Pressure Screening, Cervical Cancer Screening, Breast Cancer Screening, andColorectal Cancer Screening (Colonoscopy or Sigmoidoscopy) Logistic regression performed to determine likelihood of ever having received HIV testing andchronic disease screening between respondents, by primary source of care.MethodsProposal ID #: 1638481Variable Name N % 95% CIReported HIV Test, Prior Yr. 8939 17.6 10.7-24.6Reported HIV Test, Ever 21882 44.4 52.0-57.0BP Screen, Prior Yr. 45527 89.8 89.3-90.3Pap Smear, Prior 2 Yrs. 21700 83.6 82.4- 84.9Pap Smear, Ever 25611 95.9 95.4-96.3Mammography, Prior 2 Yrs. 13899 82.6 81.2-83.9Mammography, Ever 16024 92.8 92.0 -93.8GI Endoscopy, Prior 10 Yrs. 13306 58.2 55.9-60.6GI Endoscopy, Ever 14212 62.2 59.6-64.9Table 1: Proportion of Respondents TestedScreening Measure OR 95 % CIHIV Test, EverCommunity Health Clinic 1.94 1.51-2.51ED 3.33 0.92-8.28Source of Care None/Other 1.49 1.23-1.52BP Screen, Prior yearCommunity Health Clinic 0.23 0.05-1.03ED 0.03 0.01-0.15Source of Care None/Other 0.14 0.07-0.26Pap Smear, EverCommunity Health Clinic 1.62 0.51-5.13ED 0.40 0.22-0.73Source of Care None/Other 0.38 0.29-0.50Mammogram, EverCommunity Health Clinic 0.77 0.37-1.62ED 0.25 0.13-0.51Source of Care None/Other 0.50 0.39-0.65Colonoscopy, EverCommunity Health Clinic 0.91 0.58-1.43ED 3.12 0.35-27.9Source of Care None/Other 0.71 0.59-0.85Table 2: Odds of Testing and Screening inother Settings Compared to Private ClinicsResults Routine opt-out HIV testing has beenrecommended by the CDC since 2006 andproposed by the USPSTF in 2013Overall rates of HIV testing haveincreased since 2006 CDCrecommendations. Increase in rates largely attributable to:• Community Clinics• Emergency Departments• Non-traditional Primary Care settings Primary Care Providers have reportedmultiple barriers to routine opt-out HIVtesting. Data regarding actual HIV testing practicesof primary providers is lacking.Objective: Determine how rates of HIV testingcompare with other routine screeningmeasures overall & in the primary caresetting . Gain a better under standing of HIVtesting practices by private practiceprimary care providers.Results 50,698 individuals surveyed, ≈ 10,000/yr. Mean age 40 yrs., majority Caucasian(69.2%) and female (53.3%). Primary source of medical care: 79.1 % Private Clinic 4.2% Community Health Clinic 2.5% Emergency Department 14.2% reported as none or ‘other’OR - Odds Ratio; ED - Emergency Department