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

Abstract

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%) (β=–0.16, p<0.001) and then increased immediately after release of the recommendations, but decreased to 3.7% after 2009 (β=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. Conclusion. 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.