Marc Pitasi, MPH, CDC epidemiologist and co-author of the CDC study, stated that the study did not investigate the reasons for not testing. However, it found that the majority of people preferred the test in a clinical setting, which is a significant piece of the puzzle.
The study shows that the never-tested population, comprising 4334 of 6072 participants, was mainly between ages 18 to 29 years and 50 years plus. Additionally, 48% of never-tested adults indicated that they had engaged in past-year risky behaviors, which included injection drug use, treated for a sexually transmitted disease, exchanged sex/drugs for money, engaged in condomless anal sex, or had > 4 sex partners. The difference between never-tested adults residing in Ending the HIV Epidemic in the US (EHE)-designated jurisdictions and those residing in non-EHE areas was only about 5 percentage points, underscoring the need for broader engagement.
Seventeen years have passed since the CDC recommended that HIV testing and screening be offered at least once to all people aged 13 to 64 years in a routine clinical setting, with an opt-out option and without a separate written consent. Despite numerous organizations, including the US Preventive Services Task Force (USPSTF) in 2013 and again in 2019, and the American Academy of Pediatrics (AAP) in 2021 reinforcing the recommendations, some clinicians remain unaware of the guidelines, while others prioritize conflicting issues. Pediatricians are an example of a group who rarely take advantage of HIV testing opportunities during routine clinical visits.
According to Scott Harris, MD, MPH, state health officer of the Alabama Department of Public Health, a fractured, often ill-funded US healthcare system could also be at play. Although COVID diverted attention away from HIV, some states have prioritized HIV more than others. Harris stated that “there’s a general consensus among everyone in public health that [HIV testing] is an important issue that we’re not addressing as well as we’d like to.”
To overcome the barriers, the study suggests offering testing in clinical settings, which most participants prefer. Furthermore, pediatricians should prioritize HIV testing and prevention by offering it universally and without linking it to sexual activity. Medical assistants could be involved in re-designed workflows to ease physicians’ and nurse practitioners’ burden. Finally, a nationwide public health program is necessary to prioritize HIV testing in every state.
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