title: Relationship between a Centers for Disease Control and Prevention expanded HIV testing initiative and past-year testing by race/ethnicity: a multilevel analysis of the Behavioral Risk Factor Surveillance System.
abstract: The Centers for Disease Control and Prevention's (CDC) expanded testing initiative (ETI) aims to bolster HIV testing among populations disproportionately affected by the HIV epidemic by providing additional funding to health departments serving these communities. ETI prioritizes testing in clinical settings; therefore, we examined the relationship between state-level ETI participation and past-year HIV testing among a racially/ethnically diverse sample of adult respondents to the 2012 Behavioral Risk Factor Surveillance System who accessed health services within the 12 months prior to being interviewed. Controlling for individual- and state-level characteristics in a multilevel logistic regression model, ETI participation was independently and positively associated with past-year testing, but this association varied by race/ethnicity. Hispanics had higher odds (adjusted odds ratio [AOR]: 1.49; 95% CI: 1.11-2.02) and American Indian/Alaska Natives had lower odds (AOR: 0.66; 95% CI: 0.43-0.99) of testing if they resided in states with (vs. without) ETI participation. State-level ETI participation did not significantly alter past-year testing among other racial/ethnic groups. Prioritizing public health resources in states most affected by HIV can improve testing patterns, but other mechanisms likely influence which racial/ethnic groups undergo testing.
authors.affiliation: a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , CA , USA.
authors.forename: Tommi L
authors.initials: TL
authors.lastname: Gaines
authors.affiliation: b Department of Community Health Sciences, Fielding School of Public Health , University of California at Los Angeles , Los Angeles , CA , USA.
authors.forename: Julia T
authors.initials: JT
authors.lastname: Caldwell
authors.affiliation: b Department of Community Health Sciences, Fielding School of Public Health , University of California at Los Angeles , Los Angeles , CA , USA.
authors.forename: Chandra L
authors.initials: CL
authors.lastname: Ford
authors.affiliation: c Independent Researcher , Atlanta , GA , USA.
authors.forename: Mesfin S
authors.initials: MS
authors.lastname: Mulatu
authors.affiliation: d Division of Epidemiology and Prevention Research, National Institute of Alcohol Abuse and Alcoholism , National Institutes of Health , Rockville , MD , USA.
authors.forename: Dionne C
authors.initials: DC
authors.lastname: Godette
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D002487:Centers for Disease Control and Prevention, U.S.; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000208:ethnology* / Q000517:prevention & control* / Q000523:psychology; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D055361:Multilevel Analysis; D011159:Population Surveillance; D015397:Program Evaluation; D014481:United States / Q000453:epidemiology; D044465:White People
keywords: HIV/AIDS; multilevel; race/ethnic differences; screening; testing initiative