Impact of a routine, opt-out HIV testing program on HIV testing and case detection in North Carolina sexually transmitted disease clinics.
BACKGROUND
The impact of routine, opt-out HIV testing programs in clinical settings is inconclusive. The objective of this study was to estimate the impact of an expanded, routine HIV testing program in North Carolina sexually transmitted disease (STD) clinics on HIV testing and case detection.


METHODS
Adults aged 18 to 64 years who received an HIV test in a North Carolina STD clinic from July 1, 2005, through June 30, 2011, were included in this analysis, dichotomized at the date of implementation on November 1, 2007. HIV testing and case detection counts and rates were analyzed using interrupted time series analysis and Poisson and multilevel logistic regression.


RESULTS
Preintervention, 426 new HIV-infected cases were identified from 128,029 tests (0.33%), whereas 816 new HIV-infected cases were found from 274,745 tests postintervention (0.30%). Preintervention, HIV testing increased by 55 tests per month (95% confidence interval [CI], 41-72), but only 34 tests per month (95% CI, 26-42) postintervention. Increases in HIV testing rates were most pronounced in women and non-Hispanic whites. A slight preintervention decline in case detection was mitigated by the intervention (mean difference, 0.01; 95% CI, -0.02 to 0.05). Increases in case detection rates were observed among women and non-Hispanic blacks.


CONCLUSIONS
The impact of a routine HIV screening in North Carolina STD clinics was marginal, with the greatest benefit among persons not traditionally targeted for HIV testing. The use of a preintervention comparison period identified important temporal trends that otherwise would have been ignored.
From the *Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI; †Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC; ‡School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR; §Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC; and ¶HIV/STD Prevention and Care Branch, North Carolina Division of Public Health, Raleigh, NC.
Pamela W
PW
Klein
Lynne C
LC
Messer
Evan R
ER
Myers
David J
DJ
Weber
Peter A
PA
Leone
William C
WC
Miller
D000293:Adolescent; D000328:Adult; D016358:Contact Tracing; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D065186:Interrupted Time Series Analysis; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance