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Siddiqi KA, Gwynn M, Olatosi B, Ostermann J. Associations Between Clinic-Based HIV Testing Guidelines and Population-Level HIV Testing Rates in the United States. J Assoc Nurses AIDS Care 2023; 34:349-362. [PMID: 37141167 DOI: 10.1097/jnc.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT Between 2005 and 2006, the United States Preventive Services Task Force and the Centers for Disease Control and Prevention revised their risk-based HIV testing guidelines to include universal HIV testing in routine health care. We examined trends in HIV testing and associations with changing policy recommendations using the 2000-2017 National Health Interview Surveys. Multivariable logistic regression and difference-in-difference approach were used to assess rates and correlates of HIV testing before and after the policy changes. Changes in recommendations had minimal effects on overall HIV testing rates but had significant effects on selected subpopulations. The odds of HIV testing increased disproportionately among African Americans, Hispanics, individuals with some college education, low perceived HIV risks, and those who were never married but decreased among those with no regular source of care. A strategy combining risk-based and routine opt-out testing holds promise to rapidly link recently infected individuals to care while reaching individuals who have never been tested.
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Affiliation(s)
- Khairul A Siddiqi
- Khairul A Siddiqi, PhD, Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA. Melanie Gwynn, PhD, MPH, MHA, Department of Health Services Policy & Management, University of South Carolina, Columbia, South Carolina, USA, and South Carolina Rural Health Research Center, Columbia, South Carolina, USA. Bankole Olatosi, PhD, Department of Health Services Policy & Management, University of South Carolina, Columbia, South Carolina, USA. Jan Ostermann, PhD, Department of Health Services Policy & Management, University of South Carolina, Columbia, South Carolina, USA
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Vallée A, Sveltlane D, Trichereau J, Neveu S, Fourn E, Majerholc C, Lesprit P, Mazaux L, Henintsoa SH, Matejczuk G, Vasse M, Zucman D. Electronic medical record alert increases HIV screening rates: the Foch hospital pilot POP-up project. BMC Health Serv Res 2022; 22:784. [PMID: 35710554 PMCID: PMC9202097 DOI: 10.1186/s12913-022-08176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 06/13/2022] [Indexed: 12/05/2022] Open
Abstract
Background Despite significant national human immunodeficiency virus (HIV) screening activity, there are persistent delays in screening, and many missed diagnostic opportunities. To facilitate targeted screening, an electronic medical record (EMR) alert reminder was applied in the Foch hospital. Screening rates after implementation were reported. Methods A prospective cohort analysis was performed in Foch Hospital between 24 April 2018 and 4 October 2019 among hospitalized patients born in high HIV prevalence countries and/or having social vulnerability criteria (universal health coverage). From the admissions software, when specific low health coverage was provided and/or high-prevalence country of birth was registered, an electronic alert (EMR alert) appeared on the ward where the patient was hospitalized. The EMR alert database was examined for HIV screening and activity responses from each service of the Hospital. Results Eight thousand one hundred eighty-one alerts were recovered during the period for 1448 patients. 27 services used the EMR alert. Most of the alerts were directly closed (74.4%), 14.5% of the alerts were closed due to doctors declaring that they did not have time to respond. 297 (3.6%) of the 8181 alerts resulted in a prescription of HIV serology corresponding for 20.5% of the patients. Conclusion EMR alert can help to increase the rate of HIV screening in hospital care practice. Through this EMR alert system, HIV screening can be implemented as a common practice like any other medical alternative. Future research should examine the factors influencing physicians’ attitudes to this alert system to improve the HIV screening rate.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology - Data - Biostatistics, Delegation of Clinical Research and Innovation, Foch Hospital, Suresnes, France.
| | - Dimi Sveltlane
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Julie Trichereau
- Department of Epidemiology - Data - Biostatistics, Delegation of Clinical Research and Innovation, Foch Hospital, Suresnes, France
| | - Stéphane Neveu
- Département d'Informatique, Hôpital Foch, Suresnes, France
| | - Erwan Fourn
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Catherine Majerholc
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Philippe Lesprit
- Department of Hygiene and Infectious Disease, Foch Hospital, Suresnes, France
| | - Laurence Mazaux
- Service de Biologie Clinique, Hôpital Foch, Suresnes, France
| | - Seheno Harijaona Henintsoa
- Department of Epidemiology - Data - Biostatistics, Delegation of Clinical Research and Innovation, Foch Hospital, Suresnes, France
| | | | - Marc Vasse
- Service de Biologie Clinique, Hôpital Foch, Suresnes, France
| | - David Zucman
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
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Cianelli R, Villegas N, Oliveira GD, Sailsman S, Montano NP, Martinez AS, Toledo C, Sandalaula M, Sanchez H. Exploring the Psychosocial Impact of Living With HIV on Minority Older Women. J Am Psychiatr Nurses Assoc 2022; 28:216-224. [PMID: 32469282 DOI: 10.1177/1078390320927462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Among older adults, minority older women will account for 60% of the new HIV diagnoses. The psychosocial impact of living with HIV among this vulnerable population narrated by their own voices has been understudied. AIMS: The purpose of this study was to explore the psychosocial impact of living with HIV on minority older women. METHODS: In-depth interviews were conducted with 28 minority older women living with HIV at an Ambulatory Care Center HIV Clinic in South Florida. All interviews were audio-recorded and transcribed verbatim. Conventional content analysis was used to identify and define the major themes that emerged from the interviews. Questions included those concerning description of life after the HIV diagnosis, most challenging aspects of life after the diagnosis, and daily activities since the diagnosis. RESULTS: The analysis of the interview data led to five main themes: (I) Social Impact of HIV, (II) Threats to Health and Well-Being, (III) HIV as a Death Sentence, (IV) Spirituality, and (V) HIV Treatment Adherence. In their narratives, women described a myriad of psychosocial issues such as depressed mood, isolation, economic challenges, stigma, anhedonia of interest, fear of death, among others. CONCLUSIONS: There is a compelling empirical need for rapid implementation of a culturally tailored, holistic, low-cost, multistrategy intervention to early screen and reduce the psychosocial impact of HIV among minority older women.
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Affiliation(s)
- Rosina Cianelli
- Rosina Cianelli, PhD, MPH, RN, IBCLC, FAAN, University of Miami, Coral Gables, FL, USA
| | - Natalia Villegas
- Natalia Villegas, PhD, MSN, RN, IBCLC, University of Miami, Coral Gables, FL, USA
| | - Giovanna De Oliveira
- Giovanna De Oliveira, PhD, MSN, RN, ANP-C, PMHNP-BC, University of Miami, Coral Gables, FL, USA
| | - Sonique Sailsman
- Sonique Sailsman, PhD, RN, Barry University, Miami Shores, FL, USA
| | - Nilda Peragallo Montano
- Nilda Peragallo Montano, DrPH, RN, FAAN, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Angel Solorzano Martinez
- Angel Solorzano Martinez DNP, MSN, MBA, RN, CNS, PMHNP-BC, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Christine Toledo
- Christine Toledo, PhD, MSN, RN, University of Miami, Coral Gables, FL, USA
| | - Muheriwha Sandalaula
- Muheriwha Sandalaula, PhDc, MScMid, RN, University of Miami, Coral Gables, FL, USA
| | - Heather Sanchez
- Heather Sanchez, RN, University of Miami, Coral Gables, FL, USA
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Kurtzman ET, Wyche KF. Prevalence and Correlates of HIV Testing among Sexual Minorities. Am J Health Behav 2021; 45:879-894. [PMID: 34702435 DOI: 10.5993/ajhb.45.5.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: We established baseline prevalence rates of HIV testing among adult, sexual minorities and identified the correlates of never being HIV tested. Methods: We used a 20-state sample of the 2017-2019 Behavioral Risk Factor Surveillance System to identify sexual minorities who responded to the HIV testing question (N=433,042). Using weighted multivariate logistic regression analysis, we identified the characteristics associated with never being HIV tested and the impact of state health departments' HIV testing messages on testing status. Results: Overall, 41.6% of sexual minorities reported never being HIV tested with statistically significant state-level variation. Being younger (18-24 years) or older (65+ years), not black, married, and in good health significantly increased the odds of never being HIV tested as did lacking regular healthcare access and reporting no high-risk HIV behaviors. States' HIV testing messages had no statistically significant effect on HIV testing status. Conclusions: Although sexual minorities were less likely than straight respondents to report never being HIV tested, a sizable population remained untested. Specific characteristics associated with sexual minorities' HIV testing status can be used to tailor public health messages and optimize testing rates.
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Affiliation(s)
- Ellen T. Kurtzman
- Ellen T. Kurtzman, Associate Professor, School of Nursing, The George Washington University, Washington, DC, United States;,
| | - Karen Fraser Wyche
- Karen Fraser Wyche, Clinical Professor, School of Nursing, The George Washington University, Washington, DC, United States
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Johnson AS, Song R. Incident and Prevalent HIV Infections Attributed to Sexual Transmission in the United States, 2018. Sex Transm Dis 2021; 48:285-291. [PMID: 33492096 PMCID: PMC10176536 DOI: 10.1097/olq.0000000000001354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Ending the HIV Epidemic: A Plan for America initiative aims to reduce new infections by 2030. Routine assessment of incident and prevalent HIV by transmission risk is essential for monitoring the impact of national, state, and local efforts to end the HIV epidemic. METHODS Data reported to the National HIV Surveillance System were used to estimate numbers of incident and prevalent HIV infection attributed to sexual transmission in the United States in 2018. The first CD4 result after diagnosis and a CD4 depletion model were used to generate estimates by transmission category, sex at birth, age group, and race/ethnicity. RESULTS In 2018, there were an estimated 32,600 (50% confidence interval [CI], 31,800-33,400) incident and 984,000 (50% CI, 977,000-990,900) prevalent HIV infections attributed to sexual transmission in the United States. Male-to-male sexual contact comprised 74.8% and 69.1% of incident and prevalent HIV infections, respectively. Persons aged 25 to 34 years comprised 39.6% (12,900; 50% CI, 12,400-13,400) of incident infections; however, the number of prevalent infections was highest among persons 55 years and older (29.3%; 288,300 [50% CI, 285,600-291,000]). There were racial/ethnic differences in numbers of incident and prevalent infections among both men who have sex with men and persons with HIV attributable to heterosexual contact. CONCLUSIONS In 2018, most incident sexually transmitted HIV infections occurred in men who have sex with men, and the burden was disproportionate for persons aged 24 to 35 years, and Black/African American and Hispanic/Latino adults and adolescents. Efforts to increase the use of effective biomedical and behavioral prevention methods must be intensified to reach the goal to end the HIV epidemic in the United States.
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Affiliation(s)
- Anna Satcher Johnson
- From the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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McMillan JM, Krentz H, Gill MJ, Hogan DB. Managing HIV infection in patients older than 50 years. CMAJ 2019; 190:E1253-E1258. [PMID: 30348740 DOI: 10.1503/cmaj.171409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jacqueline M McMillan
- Department of Medicine (McMillan, Krentz, Gill, Hogan), University of Calgary; Southern Alberta Clinic (Krentz, Gill), Calgary, Alta.
| | - Hartmut Krentz
- Department of Medicine (McMillan, Krentz, Gill, Hogan), University of Calgary; Southern Alberta Clinic (Krentz, Gill), Calgary, Alta
| | - M John Gill
- Department of Medicine (McMillan, Krentz, Gill, Hogan), University of Calgary; Southern Alberta Clinic (Krentz, Gill), Calgary, Alta
| | - David B Hogan
- Department of Medicine (McMillan, Krentz, Gill, Hogan), University of Calgary; Southern Alberta Clinic (Krentz, Gill), Calgary, Alta
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Rural-Urban Differences in Human Immunodeficiency Virus Testing Among US Adults: Findings From the Behavioral Risk Factor Surveillance System. Sex Transm Dis 2019; 45:808-812. [PMID: 29965946 DOI: 10.1097/olq.0000000000000888] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals in rural areas of the United States face barriers to human immunodeficiency virus (HIV)-related health care. We aim to assess differences in frequency of lifetime and past-year HIV testing, and differences in testing site location between rural and urban residents of the United States. METHODS Data from the Behavioral Risk Factor Surveillance System 2015 were analyzed on 250,579 respondents 18 years or older. Weighted multinomial logistic regression analyses compared urban/rural differences in lifetime and past-year HIV testing. Weighted multinomial logistic regression compared urban/rural differences in HIV testing site. RESULTS Overall, 26.9% of urban residents and 21.5% of rural residents reported testing for HIV in their lifetime. Of urban residents, 24.5% reported receiving an HIV test in the past year compared with 20.2% of rural residents. Living in a rural area was associated with lower odds of lifetime (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.81-0.90) and past-year HIV testing (OR, 0.84; 95% CI, 0.74-0.95) compared with not testing. Rural residents had higher odds of receiving an HIV test at the hospital or emergency room (adjusted OR, 1.41; 95% CI, 1.23-1.62) or clinic (adjusted OR, 1.21; 95% CI, 1.02-1.24) than a doctor's office. CONCLUSIONS This study highlights significant rural health disparities in rates of lifetime and past-year HIV testing. Targeted interventions are needed to remove structural barriers in rural communities, such as long distances to clinics and low availability of free HIV testing at clinics serving the uninsured or underinsured. Furthermore, rural providers should be encouraged to routinely offer HIV screening to their patients.
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Kahle EM, Suarez N, Sharma A, Sullivan S, Stephenson R. Threat and impact of HIV compared to other health conditions among an online sample of gay, bisexual and other men who have sex with men in the U.S. AIDS Care 2019; 32:608-615. [PMID: 31167542 DOI: 10.1080/09540121.2019.1626341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Gay, bisexual and other men who have sex with men (GBMSM) experience greater health disparities, and concern about other health conditions may decrease engagement in HIV prevention. This study assessed perceived threat and impact of HIV relative to other health concerns among GBMSM. Data were from a national online survey of GBMSM conducted between August and September 2015. Participants ranked concern about contracting HIV and impact of HIV on their health compared with other health conditions. The association of HIV threat and impact with recent condomless anal sex (CAS) and HIV testing were assessed using regression models. Among 466 participants, threat and impact of HIV were ranked lower compared to cancer, Alzheimer's and heart disease. Concern about getting HIV was associated with greater odds of recent HIV testing (adjOR 1.1, 95%CI 1.02-1.18) and lower CAS (adjOR 0.86, 95%CI 0.78-0.94). Among GBMSM, other health conditions may be perceived as a greater threat and higher impact on health compared with HIV. Integrating complex health care concerns with HIV prevention strategies may increase engagement in prevention.
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Affiliation(s)
- Erin M Kahle
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Suarez
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Sullivan
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
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Oraka E, Mason S, Xia M. Too old to test? Prevalence and correlates of HIV testing among sexually active older adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:460-470. [PMID: 29583105 DOI: 10.1080/01634372.2018.1454565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Older adults account for 17% of new HIV diagnoses in the US and are more likely to be diagnosed with HIV later in the course of the disease compared to younger people. We calculated the prevalence and associated factors of having ever been tested for HIV among sexually active older adults. We analyzed data from the 2008-2016 General Social Survey Limited to respondents ≥65 years of age who reported more than one sex partner(s) in past 12 months (n = 757). HIV testing prevalence, prevalence ratios, and 95% confidence intervals were calculated by demographic variables and HIV-related risk behaviors. An estimated 16.3% of sexually active older adults have tested for HIV, and 15.9% were at increased risk for HIV infection (reported injection drug and/or crack-cocaine use, exchanging money for sex, more than three sex partners in the past year, or men who reported having sex with another man). In the adjusted model, adults aged 65-70, not married, self-identified as gay/bisexual, and at increased risk for HIV infection were more likely to have tested for HIV. An estimated 83.7% of sexually active older adults never tested for HIV. Strategies are needed to increase HIV awareness and testing among potentially high-risk older adults.
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Kershaw C, Taylor JL, Horowitz G, Brockmeyer D, Libman H, Kriegel G, Ngo L. Use of an electronic medical record reminder improves HIV screening. BMC Health Serv Res 2018; 18:14. [PMID: 29316919 PMCID: PMC5761195 DOI: 10.1186/s12913-017-2824-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 12/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background More than 1 in 7 patients with human immunodeficiency virus (HIV) infection in the United States are unaware of their serostatus despite recommendations of US agencies that all adults through age 65 be screened for HIV at least once. To facilitate universal screening, an electronic medical record (EMR) reminder was created for our primary care practice. Screening rates before and after implementation were assessed to determine the impact of the reminder on screening rates. Methods A retrospective cohort analysis was performed for patients age 18–65 with visits between January 1, 2012-October 30, 2014. EMR databases were examined for HIV testing and selected patient characteristics. We evaluated the probability of HIV screening in unscreened patients before and after the reminder and used a multivariable generalized linear model to test the association between likelihood of HIV testing and specific patient characteristics. Results Prior to the reminder, the probability of receiving an HIV test for previously unscreened patients was 15.3%. This increased to 30.7% after the reminder (RR 2.02, CI 1.95–2.09, p < 0.0001). The impact was most significant in patients age 45–65. White race, English as primary language, and higher median household income were associated with lower likelihoods of screening both before and after implementation (RR 0.68, CI 0.65–0.72; RR 0.74, CI 0.67–0.82; RR 0.84, CI 0.80–0.88, respectively). Conclusions The EMR reminder increased rates of HIV screening twofold in our practice. It was most effective in increasing screening rates in older patients. Patients who were white, English-speaking, and had higher incomes were less likely to be screened for HIV both before and after the reminder.
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Affiliation(s)
- Colleen Kershaw
- Department of Medicine, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA, 02215, USA.
| | - Jessica L Taylor
- Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2, Boston, MA, 02118, USA
| | - Gary Horowitz
- Department of Pathology, Tufts Medical Center, Biewend Building 3, 800 Washington St, Boston, MA, 02111, USA
| | - Diane Brockmeyer
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Howard Libman
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Gila Kriegel
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
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