Trends in HIV Testing Among U.S. Older Adults Prior to and Since Release of CDC's Routine HIV Testing Recommendations: National Findings from the BRFSS.
OBJECTIVE
This study examined temporal trends in HIV testing among U.S. older adults (50-64 years of age) before and after the release of CDC's routine HIV testing recommendations in 2006.


METHODS
The sample (n=872,797; 51.4% female) comprised 2003-2010 Behavioral Risk Factor Surveillance System respondents in the oldest categories to which the recommendations apply: 50-54 years (34.5%, n=301,519), 55-59 years (34.1%, n=297,865), and 60-64 years (31.3%, n=273,413). We calculated (1) four-year pooled prevalences of past-year HIV testing before and after 2006, when the recommendations were released; and (2) annual prevalences of HIV testing overall and by age category from 2003-2010. Using weighted, multivariable logistic regression analyses, we examined binary (pre- vs. post-recommendations) and annual changes in testing, controlling for covariates. We stratified the data by recent doctor visits, examined racial/ethnic differences, and tested for linear and quadratic temporal trends.


RESULTS
Overall and within age categories, the pooled prevalence of past-year HIV testing decreased following release of the recommendations (p<0.001). The annual prevalence decreased monotonically from 2003 (5.5%) to 2006 (3.6%) (b=-0.16, p<0.001) and then increased immediately after release of the recommendations, but decreased to 3.7% after 2009 (b=0.01, p<0.001). By race/ethnicity, testing increased over time among non-Hispanic black people only. Annual prevalence also increased among respondents with recent doctor visits.


CONCLUSIONS
CDC's HIV testing recommendations were associated with a reversal in the downward trend in past-year HIV testing among older adults; however, the gains were neither universal nor sustained over time.
University of California at Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA.
Chandra L
CL
Ford
Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA.
Mesfin S
MS
Mulatu
National Institutes of Health, National Institute of Alcohol Abuse and Alcoholism, Division of Epidemiology and Prevention Research, Rockville, MD.
Dionne C
DC
Godette
University of California at San Diego, Division of Global Public Health, Department of Medicine, San Diego, CA.
Tommi L
TL
Gaines
D015492:AIDS Serodiagnosis / Q000592:standards* / Q000639:trends; D017677:Age Distribution; D040343:Behavioral Risk Factor Surveillance System; D002487:Centers for Disease Control and Prevention, U.S. / Q000592:standards; D004522:Educational Status; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017533:Marital Status; D008403:Mass Screening / Q000592:standards* / Q000639:trends; D008875:Middle Aged; D054525:Minority Health / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D015995:Prevalence; D012309:Risk-Taking; D014481:United States / Q000453:epidemiology