title: HIV Screening Rates among Medicaid Enrollees Diagnosed with Other Sexually Transmitted Infections.
abstract: BACKGROUND
  Approximately 20 million new sexually transmitted infections (STIs) are diagnosed yearly in the United States costing the healthcare system an estimated $16 billion in direct medical expenses. The presence of other STIs increases the risk of HIV transmission. The Centers for Disease Control and Prevention (CDC) has long recommended routine HIV screening for individuals with a diagnosed STI. Unfortunately, HIV screening prevalence among STI diagnosed patients are still sub-optimal in many healthcare settings.
  
  
  OBJECTIVE
  To determine the proportion of STI-diagnosed persons in the Medicaid population who are screened for HIV, examine correlates of HIV screening, and to suggest critical intervention points to increase HIV screening in this population.
  
  
  METHODS
  A retrospective database analysis was conducted to examine the prevalence and correlates of HIV screening among participants. Participant eligibility was restricted to Medicaid enrollees in 29 states with a primary STI diagnosis (chlamydia, gonorrhea, and syphilis) or pelvic inflammatory disease claim in 2009. HIV-positive persons were excluded from the study. Frequencies and descriptive statistics were conducted to characterize the sample in general and by STI diagnosis. Univariate and multivariate logistic regression were performed to estimate unadjusted odds ratios and adjusted odds ratio respectively and the 95% confidence intervals. Multivariate logistic regression models that included the independent variables (race, STI diagnosis, and healthcare setting) and covariates (gender, residential status, age, and state) were analyzed to examine independent associations with HIV screening.
  
  
  RESULTS
  About 43% of all STI-diagnosed study participants were screened for HIV. STI-diagnosed persons that were between 20-24 years, female, residing in a large metropolitan area and with a syphilis diagnosis were more likely to be screened for HIV. Participants who received their STI diagnosis in the emergency department were less likely to be screened for HIV than those diagnosed in a physician's office.
  
  
  CONCLUSIONS
  This study showed that HIV screening prevalence among persons diagnosed with an STI are lower than expected based on the CDC's recommendations. These suboptimal HIV screening prevalence present "missed opportunities" for HIV screening in at-risk populations. Measures and incentives to increase HIV screening among all STI-diagnosed persons are vital to the timely identification of HIV infection, linkage to HIV care, and mitigating further HIV transmission.
authors.affiliation: Department of Community Health and Preventive Medicine, Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Oluwatoyosi A
authors.initials: OA
authors.lastname: Adekeye
authors.affiliation: Department of Community Health and Preventive Medicine, Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Winston E
authors.initials: WE
authors.lastname: Abara
authors.affiliation: National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Junjun
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Health Policy and Management, The University of Georgia, Athens, Georgia, United States of America.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Lee
authors.affiliation: National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: George
authors.initials: G
authors.lastname: Rust
authors.affiliation: Department of Community Health and Preventive Medicine, Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Satcher
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008484:Medicaid; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D062486:Public Health Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult