An Analysis of STD Screening in HIV-Infected Persons Receiving Privately Insured Medical Care

Background:  CDC guidelines recommend screening HIV-infected persons at least annually for chlamydia, gonorrhea, and syphilis, but data to determine the extent of screening are limited.  An STD in an HIV-infected person indicates high-risk behavior that could facilitate HIV transmission.

Objectives:  We sought to assess the extent to which privately-insured individuals receiving HIV care were screened at least one time in a given year for chlamydia, gonorrhea, and syphilis.

Methods:  We used a large insurance claims database containing claims data for over 39 million privately-insured persons.  We used ICD-9 diagnosis codes to identify HIV-infected patients, and used Current Procedures Terminology (CPT) codes to identify claims for tests for syphilis, chlamydia, and gonorrhea.  We analyzed patients by age group, sex, type of health plan, and region of the country.

Results: We found 15,977 HIV-infected patients, 69% of whom were male.  Testing rates were 19.5% for chlamydia, 19.2% for gonorrhea, and 41.8% for syphilis.  Patients in point of service (POS) plans without capitation were more likely than patients in preferred provider organizations (PPOs) to be tested for chlamydia (22.3% vs. 18.7% and gonorrhea (21.9% vs. 18.3%), p<0.05. Patients in the west were more likely than patients in the northeast to be tested for syphilis (44.9% vs. 33.9%), p<0.05. There were no significant differences in testing rates by sex or age group.

Conclusions: Testing rates for patients in HIV care are low, with some regional and insurance-related significant differences.  Testing rates were highest for syphilis, which is the rarest of the three STDs analyzed.

Implications for Programs, Policy, and Research: These data indicate areas for further evaluation to explain differences in testing practices and could suggest interventions aimed at providers and insurers to expand testing in patients.