Background The CDC has recommended HIV testing for persons with a suspected STD since 1987 and for all patients in clinical settings since 2006. However, HIV testing of suspected STD patients in emergency medical sites is inadequate, despite the high risk of HIV acquisition in this population. Community health centers may have better adherence to HIV testing recommendations due to a more personal relationship with their clientele and heightened awareness of state disease trends.

Methods Robeson Healthcare Corporation is a federally-qualified health center with 4 sites located in a county in the top 10% of HIV case rates and top 33% of syphilis case rates in North Carolina. A routine HIV testing program was started in June 2009. Patients receiving an STD evaluation 1 June 2009 through 31 January 2011 were examined for concurrent HIV testing. The association between age and HIV testing among STD testers was assessed with multivariate logistic regression with a robust variance estimator to account for patients with multiple clinic visits.

Results Of the 6588 clinic visits that included an STD evaluation, 2324 also included an HIV test (35.3%, 95% CI 32.1 to 36.4%). Over 70% of patients tested for syphilis also received an HIV test (n=1531/2111, 72.5%, 95% CI 70.6 to 74.4%). Less than 30% of patients screened for gonorrhoea and Chlamydial infections were also tested for HIV (n=1545/5442, 28.4%, 95% CI 27.2 to 29.6%). During a statewide syphilis outbreak in 2009 with high HIV-syphilis coinfection rates, HIV testing of suspected syphilis patients reached 84.0% (95% CI 80.9 to 87.0%). Patients of older ages were less likely to be tested for HIV during their STD evaluation than patients of younger ages (Abstract P1-S6.30 table 1).

Conclusions In this community health center population, over 70% of patient visits with a syphilis evaluation included a concurrent HIV test order. This represents an improvement from an emergency department setting, in which less than 30% of syphilis testers were also tested for HIV. However, HIV testing among patients screened for gonorrhoea and Chlamydial infection was still low; the inclusion of HIV testing in the standard order panel for patients receiving an STD evaluation may increase HIV testing in this high-risk population.