1533HIV Testing in a Primary Care Clinic: Missed Opportunities for Testing Older Adults

Background. Older adults (age > 50 years) continue to represent 17% of the new HIV diagnoses each year in the U.S. and are often diagnosed later in the course of their disease. In 2010, 46% of the newly diagnosed HIV infected adults over 50 had AIDS within 12 months of their diagnosis. These realities led the authors to investigate how HIV risk assessment and testing practices within a primary care practice varied between older and younger patients. Methods. 150 participants were recruited from the waiting room of an internal medicine clinic in a large academic medical center in New York City. Eligible subjects spoke English or Spanish, considered a medical provider in the clinic to be their primary doctor, and had attended at least two visits with their provider in the prior year. Participants completed a single computer-based survey that took less than 20 minutes in a private room. Data was analyzed using SPSS. Funding was available through a Pfizer Independent Research Grant. Results. 148 participants (ages 21-91) completed the survey and were representative of the study clinic population. Older patients (> 50 years, N = 99) were compared to younger patients (N = 49). Older patients were less likely to have been previously tested for HIV (66.7 vs 87.8%, p = .0076) and to have had their medical provider recommend an HIV test (28.3 vs 55.1%, p = .0017). Older patients were less likely to have had medical provider discuss HIV risk behaviors with them including sexual activity (28.3 vs 55.1%, p = .0015), condom use (22.2 vs 53.1%, p = .0001), prior STIs (34.3 vs 63.3%, p = .0005), sexual abuse (17.2 vs 38.8%, p = .003), drug use (40.4 vs 69.4%, p = .0005), and incarceration (14.1 vs 34.7%, p = .003). Fewer older adults reported sex in the last year (53.5 vs 81.6%, p = .0009) but were twice as likely to have lost a main partner to death or illness (24.7 vs 10.2%, p = .038). Both groups reported similar numbers of lifetime sexual partners (15.2 vs 11.6, p = .65) and prior STIs (18.2 vs 16.3%, p = .76). Conclusion. This study suggests providers continue to screen older adults significantly less often for HIV risk factors and are less likely to recommend risk based or routine HIV screening for older adults. Moving forward, prevention of the complications of late HIV diagnosis among older adults will require focus on routine HIV screening and risk based targeted screening for adults greater than 50 years of age. Disclosures. E. Morrison, Pfizer: study funded by independent research grant, Grant recipient