Frequency of human immunodeficiency virus (HIV) testing in urban vs. rural areas of the United States: Results from a nationally-representative sample

BMC Public Health

Research Article

Michael E Ohl¹  Eli Perencevich¹ 

[1] VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VAMC, Iowa City, IA, USA;Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), at the Iowa City VA Medical Center, Iowa City, IA, USA;Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA;

关键词: Human Immunodeficiency Virus;    Human Immunodeficiency Virus Infection;    Acquire Immune Deficiency Syndrome;    Behavioral Risk Factor Surveillance System;    Human Immunodeficiency Virus Testing;   

DOI  :  10.1186/1471-2458-11-681

 received in 2011-04-12, accepted in 2011-09-01,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundStudies in the United States show that rural persons with HIV are more likely than their urban counterparts to be diagnosed at a late stage of infection, suggesting missed opportunities for HIV testing in rural areas. To inform discussion of HIV testing policies in rural areas, we generated nationally representative, population-based estimates of HIV testing frequencies in urban vs. rural areas of the United States.MethodsSecondary analysis of 2005 and 2009 Behavioral Risk Factor Surveillance System (BRFSS) data. Dependent variables were self-reported lifetime and past-year HIV testing. Urban vs. rural residence was determined using the metropolitan area framework and Urban Influence Codes and was categorized as 1) metropolitan, center city (the most urban); 2) metropolitan, other; 3) non-metropolitan, adjacent to metropolitan; 4) non-metropolitan, micropolitan; and 4) remote, non-metropolitan (the most rural).ResultsThe 2005 sample included 257,895 respondents. Lifetime HIV testing frequencies ranged from 43.6% among persons residing in the most urban areas to 32.2% among persons in the most rural areas (P < 0.001). Past-year testing frequencies ranged from 13.5% to 7.3% in these groups (P < 0.001). After adjusting for demographics (age, sex, race/ethnicity, and region of residence) and self-reported HIV risk factors, persons in the most remote rural areas were substantially less likely than persons in the most urban areas to report HIV testing in the past year (odds ratio 0.65, 95% CI 0.57-0.75). Testing rates in urban and rural areas did not change substantively following the 2006 Centers for Disease Control and Prevention recommendation for routine, population-based HIV testing in healthcare settings. In metropolitan (urban) areas, 11.5% (95% CI 11.2-11.8) reported past-year HIV testing in 2005 vs. 11.4% (95% CI 11.1%-11.7%) in 2009 (P = 0.93). In non-metropolitan areas, 8.7% (95% CI 8.2%-9.2%) were tested in 2005 vs. 7.7% (95% CI 7.2%-8.2%) in 2009 (P = 0.03).ConclusionsRural persons are less likely than urban to report prior HIV testing, which may contribute to later HIV diagnosis in rural areas. There is need to consider strategies to increase HIV testing in rural areas.

【 授权许可】

CC BY   
© Ohl and Perencevich; licensee BioMed Central Ltd. 2011