Assessing the National Prevalence of HIV Screening in the United States using Electronic Health Record Data

Abstract

The Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend population-based screening for human immunodeficiency virus (HIV) at least once in each patient's life. National surveys estimate that 42.5% of the population has been screened; however, these studies have relatively low sample sizes and inherent survey biases. Using a national, de-identified cloud-based electronic health record (EHR) information from over 48 million patients, we found that only 6.4% of Americans over the age of 18 had laboratory evidence of a prior HIV test. Further investigation is necessary to determine if single-item questions on national surveys correlate with objective evidence of HIV testing, as well as addressing the numerous limitations related to the use of EHR data that likely grossly underestimates the prevalence of HIV screening nationally.

Prevalence of Human Immunodeficiency Virus and Opportunistic Infections Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Database Study

“…Although it is possible that the Explorys database may not contain a representative sample of clinical settings where individuals seek care for HIV, the prevalence of PLWH in Explorys is 0.33%, which approximates the Centers for Disease Control and Prevention reported prevalence of 0.37% in the United States. 37 Nevertheless, information from patients who receive screening through non-hospital systems, such as county health departments, stand-alone sexually transmitted disease clinics, and Free Clinics, are not included in the Explorys database. 37 By addressing these limitations in the future, cloud-based EHR data could be used to frequently monitor the health needs of this minority patient population on a national level compared to primary reliance on survey studies that have significant limitations.…”

“… 37 Nevertheless, information from patients who receive screening through non-hospital systems, such as county health departments, stand-alone sexually transmitted disease clinics, and Free Clinics, are not included in the Explorys database. 37 By addressing these limitations in the future, cloud-based EHR data could be used to frequently monitor the health needs of this minority patient population on a national level compared to primary reliance on survey studies that have significant limitations.…”

Technology-Delivered Intervention Strategies to Bolster HIV Testing

“…However, two-thirds of those at high risk for infection who visited a healthcare provider in the past year were not offered an HIV test [4]. Using electronic health records, investigators found that only 6.4% of Americans over 18 years had any laboratory evidence of a prior HIV test [5]. These findings fall This article is part of the Topical Collection on Behavioral-Bio-Medical Interface far short of the United Nations' 90-90-90 treatment goal that by 2020, 90% of all people living with HIV will know their status, 90% of all people with diagnosed infection will receive sustained antiretroviral treatment (ART), and 90% of all people receiving ART will achieve viral suppression [6].…”