Background: Although routine HIV testing programs aim to identify persons earlier in the course of their HIV infection, the results of extant HIV testing programs are inconclusive. The objective of this study was to estimate the impact of a routine, opt-out HIV testing program in North Carolina sexually transmitted disease (STD) clinics on the risk of progression to AIDS after HIV diagnosis.
Methods: North Carolina residents aged 18-64 identified as new HIV-infected cases in North Carolina STD clinics from July 1, 2005 through June 30, 2011 were included. Exposure status was dichotomized on the date of intervention implementation on November 1, 2007. Risk of progression to AIDS within 12 months of initial HIV diagnosis was analyzed using county-specific random-intercept multilevel binomial regression models to calculate risk ratios (RRs) and 95% confidence intervals (95% CIs).
Results: Of the 1203 persons newly diagnosed with HIV infection, 12% and 13% were diagnosed with AIDS within 12 months of their initial HIV diagnosis in the pre- and post-intervention periods, respectively. Overall, we did not observe an association between the introduction of the expanded HIV testing program and the risk of progression to AIDS (RR=1.04, 95% CI: 0.77-1.43). The intervention was associated with an increased risk of progression to AIDS among women (RR=2.32, 95% CI: 1.06-4.83) and persons who had previously been tested for HIV (RR=1.42, 95% CI: 0.92-2.19).
Conclusions: Overall, the routine, opt-out HIV testing program was not associated with a decreased risk of progression to AIDS. Among some subpopulations, the increased risk of progression to AIDS post-intervention was likely due to identification of persons who had been infected for many years but were not previously targeted for risk-based testing. If undiagnosed HIV-infected persons do not seek interactions with the healthcare system, they cannot benefit from routine HIV testing programs in clinical settings.