WP 8 HIV Test Seeking at STD Clinics: A Tale of 21 Cities

Wednesday, September 21, 2016
Galleria Exhibit Hall
William Pearson, PhD, FACE, Ian Spicknall, PhD, Virginia Bowen, PhD, MHS and Matthew Hogben, PhD, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Background:  Many new cases of HIV are diagnosed each year in clinical and non-clinical settings. The CDC recommends expanding HIV testing into broader settings, including STD clinics. Therefore, it is important to understand the client population seeking HIV testing services at STD clinics in order to broaden the HIV testing reach of these clinics and to deliver quality care in these non-traditional HIV venues.

Methods:  In 2013, we surveyed clients attending STD clinics in 21 U.S. cities with high STD morbidity. We identified overall demographics, client perceptions, and health services associated with HIV test seeking using logistic regression and further examined these characteristics stratified by city.   

Results:  Of 4,364 total respondents, 630 (14.4%) were seeking an HIV test. Prevalence of HIV test seeking varied by city, ranging from 4.4% in Houston to 27.3% in Cincinnati (p<.01). Demographic factors associated with HIV test seeking were older age (O.R. 1.25, 95% C.I. 1.04 – 1.50), Hispanic ethnicity (O.R. 0.69, 95% C.I. 0.52-0.92), and gay, lesbian or bi-sexual orientation (O.R. 1.99, 95% C.I. 1.64-2.42). Clinic level attributes associated with HIV test seeking were appointment availability (O.R. 1.35, 95% C.I. 1.12-1.64), cost of care (O.R. 1.32, 95% C.I. 1.08 – 1.62), perceived privacy (O.R. 1.51, 95% C.I. 1.15-1.98), and perceived expertise of the clinic (O.R. 1.58, 95% C.I. 1.20-2.09). City-level health services characteristics associated with HIV test seeking were numbers of FQHCs available in the city (O.R. 1.41, 95% C.I. 1.17-1.69).  Many of these associations were inconsistent when stratifying by city. 

Conclusions:  Our analyses demonstrate that some factors are consistently associated with HIV test seeking across cities (i.e., sexual orientation, age) while others are unique to specific cities (i.e., employment status, reason for choosing a clinic, etc.).  Therefore, it is necessary to tailor HIV care in STD clinics based on demographics, patient perceptions and ecologic health services factors.