Missed Opportunities for Human Immunodeficiency Virus (HIV) Testing at a Large Urban Healthcare System From 2010 to 2015

Background. Appropriate HIV testing of patients at risk is an important piece of the HIV care continuum. We analyzed HIV testing patterns of patients tested for other sexually transmitted infections at a large urban healthcare system in New York City. Methods. We conducted a retrospective analysis of HIV and gonorrhea/chlamydia (GC/CT) testing data from Weill-Cornell Medicine—New York Presbyterian Hospital from 2010 to 2015. Data were obtained from a laboratory database and linked to electronic health record data. Patients at risk were defined as those above age 13 and not known to be HIV positive who had a GC/CT test performed. The main outcome was proportion of patients who had an HIV test performed at the same encounter. Analysis was conducted using Stata version 14.1 with chi square testing to compare groups. Results. We analyzed 140,803 GC/CT testing encounters on 83,248 patients. Of these, 4863 (3%) were in the Emergency Department (ED), 4,338 (3%) were inpatient, and the remaining 131,602 (94%) were outpatient encounters. In total, 45% of GC/CT testing encounters had an HIV test performed at the same encounter. There was a significant increase in the proportion of patients at risk tested for HIV over time across all locations, from 43% in 2010 to 57% in 2015 (p < 0.001). Figure 1 shows the change in HIV testing frequency across different care settings. In 2015, 31% of patients at risk in the ED received a concurrent HIV test, compared with 22% of inpatients, and 59% of outpatients. Among the patients tested for HIV concurrent with GC/CT testing, 75 were HIV positive. The total number of HIV diagnoses increased but the rate of diagnoses among persons tested was similar across years (Figure 2). Among the 83,248 patients tested for GC/CT over the 5 year period, 24,252 (29%) did not receive any HIV testing. Figure 1. Figure 2. Conclusion. Concurrent HIV testing of patients being evaluated for GC/CT increased significantly from 2010 to 2015. Despite this increase, over 50% of patients receiving GC/CT testing did not receive concurrent HIV testing, and 29% never received an HIV test. There continue to be missed opportunities for testing and diagnosis of HIV among patients at risk for sexually transmitted infections. Disclosures. All authors: No reported disclosures.