HIV Testing in Primary Care is not Enough. Multiyear analysis of HIV Testing among Patient Populations within the Emergency Department and Primary Care Settings in a Safety Net System

Background- HIV testing is a necessary component for ending the HIV epidemic, yet many individuals remain untested. We sought to evaluate the rate of ever tested for HIV among patients seeking care at the emergency department in a safety net healthcare system with an established large-volume, non-targeted HIV testing program in primary care.Methods- Patient encounters were reviewed for adults without HIV and with visits to primary care (PC) clinics and/or the emergency department (ED) during 2010 to 2018. Patient-level analyses assessed rates of ‘ever tested’ and rates of ‘tested on encounter’ during the study period for PC and ED only groups. Binary logistic regression models tested for significant associations for the two outcomes with visit setting, age group, sex at birth, and race as covariates.Results- Patients seen in PC were 4 times more likely to be ever tested for HIV compared to ED only patients (aOR: 4.40; 95% CI: 4.31–4.50). The highest rate of ever tested occurred among younger Black females who were seen in PC, while the lowest rate occurred among younger Non-Black males under 30 years of age who were seen in the ED only.Conclusions- Patients who received care only in the emergency department were unlikely to ever be tested for HIV. Strategies to increase single lifetime HIV testing in EDs are needed to reach priority populations not receiving PC.