title: HIV testing in women: missed opportunities.
abstract: OBJECTIVE
  To investigate opportunities for early human immunodeficiency virus (HIV) testing of women.
  
  
  METHODS
  A retrospective cohort study design linked case reports from HIV surveillance to several statewide health-care databases. Medical encounters occurring before the first positive HIV test (missed opportunities) were categorized by diagnosis/procedure codes to distinguish visits that were likely to have prompted an HIV test. Women were categorized as late testers (AIDS diagnosis <12 months from first HIV test date), non-late testers (no AIDS diagnosis during study period or diagnosis of AIDS >12 months of HIV diagnosis), of reproductive age (13-44 years old), and not of reproductive age (>44 years old). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to estimate risk and its statistical significance.
  
  
  RESULTS
  Of 3303 HIV-infected women diagnosed during the study period, 2408 (73%) had missed opportunity visits. Late testers (39%) were more likely to be black than white (aOR 1.48, 95% CI 1.12-1.95), be older (>44 years old; aOR 7.85, 95% CI 4.49-13.7), and have >10 missed opportunity visits (aOR 2.17, 95% CI 1.62-2.91). Fifty-four percent of women >44 years old were also late testers. Women >44 years old had lower median initial CD4 counts (p<0.001). The top two procedures were the same for all groups of women but mammography was ranked fourth for women >44 years old and Papanicolau smear was ranked fourth for late testers.
  
  
  CONCLUSIONS
  Feasibility and acceptability of routine HIV testing in nontraditional health-care settings, such as mammography and Papanicolau screenings, should be explored to identify late testers and older (not of reproductive age) HIV-infected women.
authors.affiliation: Bureau of Disease Control, STD/HIV Division, South Carolina Department of Health and Environmental Control, Columbia, SC 29201, USA. duffuswa@dhec.sc.gov
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Duffus
authors.forename: Harley T
authors.initials: HT
authors.lastname: Davis
authors.forename: Michael D
authors.initials: MD
authors.lastname: Byrd
authors.forename: Khosrow
authors.initials: K
authors.lastname: Heidari
authors.forename: Terri G
authors.initials: TG
authors.lastname: Stephens
authors.forename: James J
authors.initials: JJ
authors.lastname: Gibson
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016208:Databases, Factual; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008498:Medical Record Linkage; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013022:South Carolina / Q000453:epidemiology; D016387:Women's Health; D055815:Young Adult