HIV Testing Trends Among Persons With Commercial Insurance or Medicaid

United States, 2014-2019

Kirk D. Henny, PhD; Weiming Zhu, MD, PhD; Ya-lin A. Huang, PhD; Ashley Townes, PhD; Kevin P. Delaney, PhD; Karen W. Hoover, MD

Disclosures

Morbidity and Mortality Weekly Report. 2021;70(25):905-909. 

In This Article

Discussion

HIV testing rates increased from 2014 through 2019 among persons with commercial insurance and persons with Medicaid. The proportion of persons who received HIV testing was higher among those with Medicaid than among those with commercial insurance; trends were generally similar across demographic characteristics.

Higher rates of HIV testing were expected among persons with Medicaid because Medicaid includes large proportions of persons in populations with the highest rates of HIV diagnoses. A recent study found that from 2009 to 2014 HIV testing increased in community health centers, and this trend likely continued during the period of this study.[2] Guidelines for routine opt-out and risk-based HIV testing have been widely disseminated, and testing campaigns have been conducted by public health organizations and health care systems to increase provider awareness of these recommendations. Testing also might have increased as HIV preexposure prophylaxis (PrEP) use increased during the same period because PrEP users should receive HIV testing at PrEP initiation and every 3 months thereafter.[7,8] HIV testing is a strategic priority of EHE and was included among Medicaid noncore health care quality measures for adults in 2021,[9] which could contribute to future increases in HIV testing rates.

The findings in this report are subject to at least four limitations. First, only persons with 6 months of continuous commercial insurance or Medicaid enrollment were included, which might have resulted in an underestimate or overestimate of testing rates. Length of enrollment might vary by a person's demographic characteristics and result in under- or overestimation of HIV testing rates by these characteristics. Second, because there was no link between persons included in the MarketScan and Medicaid databases, accounting for persons enrolled in both Medicaid and commercial insurance in the same year was not possible. This circumstance might have resulted in counting a person as having been tested in both the commercial insurance and Medicaid analyses in the same year. However, by limiting the analyses to persons enrolled in their health plan for at least 6 months, it is unlikely that many such persons were included in analyses for both systems. Third, Medicare recipients who were not dually enrolled in Medicaid or commercial insurance were not included, so this study included only limited HIV testing information for persons aged ≥65 years. Finally, persons receiving testing at an HIV outreach event or in a venue that did not bill a person's health insurance for the HIV test would not have been included in this study.

HIV testing rates were highest among Black persons and Hispanic persons, which is encouraging. To accomplish goals of the EHE initiative and to reduce disparities in HIV diagnoses, higher HIV testing rates are needed for all groups, but especially for some racial and ethnic minority groups.[4] A recent study found that a two- to threefold increase in HIV testing rates at ambulatory care visits would result in almost all Black men and Hispanic men receiving testing by age 39 years.[3] In another recent study, a standing order for a routine opt-out HIV test added to all blood draws in a large health care system in 2016 resulted in 35.4% of the patient population receiving an HIV test.[10] These percentages were much higher than the national percentages found in the current study (4.0% among persons with commercial insurance and 5.5% among those with Medicaid). A recent review conducted by the Community Preventive Services Task Force (CPSTF) found that testing can be efficiently increased at clinical visits by incorporating clinical decision support tools in electronic health records that generate an automated order for routine opt-out testing or risk-based testing.[5] Increased HIV testing in clinical settings is essential to achieve the goals of the EHE initiative and reduce disparities in HIV diagnoses. Public health should partner with health care systems to implement interventions, such as those reviewed by the CPSTF, that support increased testing.

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