HIV testing trends before and after legislation mandating an offer of HIV testing in New York City

Background: In 2006, the Centers for Disease Control and Prevention recommended opt-out HIV screening for individuals ages 13-64 in healthcare settings. At that time, New York State did not allow opt-out testing. Effective September 2010, new legislation expanded consent options and made New York the first to mandate an HIV test offer to all patients ages 13-64 in healthcare settings, with limited exceptions. Objective: Assess HIV testing rates among New York City (NYC) ambulatory practices before and after changes in New York State (NYS) legislation mandating an offer of HIV testing in clinical settings. Methods: The NYC Department of Health and Mental Hygiene obtained quarterly HIV testing rates at 218 ambulatory practices. Testing rates were stratified by age, from 2009 to 2011. Rates were calculated as number of patients with HIV test results over patients with visits during the same time period. Odds ratios were obtained using longitudinal modeling. Results: HIV testing rates improved after the law took effect. Odds of testing increased 200% from Q3 2010 to Q4 2011 (OR: 2.05, 95% CI: 1.16, 3.65), compared to a 7% increase during the pre-law year (Q4 2009-Q3 2010) (OR: 1.07, 95% CI: 0.88, 1.30). Improvements persisted after adjusting for age, practice type, location and baseline performance. Discussion: This evaluation found significant improvement in HIV testing rates after NYS enacted new legislation mandating an HIV test offer, particularly in age groups targeted by law. However, testing mandates should be coupled with other efforts to increase testing rates on a large scale.