Abstract
BACKGROUND: Current guidelines recommend concurrent screening for HIV and syphilis with gonorrhea and chlamydia testing. Despite this, many patients are still not screened. This study describes trends in demographics and encounter locations associated with missed opportunities for HIV and syphilis screening among patients tested for gonorrhea or chlamydia. METHODS: This is a retrospective review of all encounters with gonorrhea or chlamydia testing in a large, urban hospital from November 1, 2018, to July 31, 2021. Demographic information and encounter location were extracted from the medical record. Encounters were categorized as including both HIV and syphilis (complete) screening, HIV screening only, or neither. Logistic regression was used to examine associations between demographics and encounter location and likelihood of complete screening. RESULTS: There were 42,791 patient encounters, of which 40.2% had complete screening, 6.2% had concurrent HIV screening only, and 53.6% had no concurrent screening. Increasing age, female sex (adjusted odds ratio [aOR], 0.58; 95% confidence interval [CI], 0.55-0.61; P < 0.01), non-Hispanic Black race (aOR, 0.52; 95% CI, 0.49-0.55; P < 0.01), and public insurance (aOR, 0.72; 95% CI, 0.69-0.75; P < 0.01) were associated with lower odds of complete screening. Emergency department (ED) encounters were most likely to include complete screening (aOR, 3.11; 95% CI, 2.96-3.26; P < 0.01). CONCLUSIONS: This study found that a large proportion of patients tested for gonorrhea and chlamydia had missed opportunities for HIV and syphilis screening. Significant demographic disparities were found. The emergency department was most likely to screen for both HIV and syphilis. Decreasing disparities in screening could have profound effects on the HIV and syphilis epidemics.