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.

KEYWORDS:

• HIV/AIDS
• screening
• race/ethnic differences
• testing initiative
• multilevel

Acknowledgements

Dr. Mulatu is participating in this research in his personal capacity. The views expressed are those of the authors and do not necessarily reflect those of the National Institutes of Health, the Agency for Healthcare Research and Quality or the Centers for Disease Control and Prevention.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported by the National Institute on Drug Abuse [grant number K01DA034523]; the Eunice Kennedy Schriver National Institute of Child Health and Human Development via the California Center for Population Research at the University of California Los Angeles [grant number 5R24HD041022]; and the Agency for Healthcare Research and Quality [grant number R36HS022811–01].