Ethnicity, Language, and HIV Screening in Older Adult Safety-Net Patients

Abstract

Introduction: HIV screening should occur for all adults at least once by age 65 years. Older adults have low screening rates. Latinos, with historically low screening rates, have worse HIV outcomes than non-Hispanic White patients. Electronic health record data from a multistate network of community health centers were used to examine whether there are differences in HIV screening for Latino (English and Spanish preferring) and non-Hispanic White older adults.

Methods: Data were from the Accelerating Data Value Across a National Community Health Center Network Clinical Research Network of PCORnet from 21 states in 2012-2021 among an open cohort of patients aged 50-65 years. Relative odds of ever having received HIV screening comparing Latinos with non-Hispanic Whites using generalized estimating equation logistic regression modeling were calculated, adjusting for relevant patient-level covariates. Analyses were conducted in 2022.

Results: Among 251,645 patients, the covariate-adjusted odds of ever receiving HIV screening were 18% higher for English-preferring Latino patients (OR=1.18, 95% CI=1.11, 1.25) and 32% higher for Spanish-preferring Latinos than for non-Hispanic Whites (OR=1.32, 95% CI=1.24, 1.42).

Conclusions: Latinos seen in community health centers, regardless of language spoken, are more likely to be screened at least once for HIV than non-Hispanic Whites. This increased screening may be due at least in part to the community health center setting, a setting known to mitigate disparities, as well as due to participation efforts by community health centers in public health campaigns. Future research can prioritize understanding the cause of this relative advantage.

Figure 1.

Adjusted odds ratios of ever having a HIV screening by ethnicity/language group. Generalized estimating equations logistic model adjusted for age, sex, insurance coverage, income, visits per year, substance use disorder, new patient visits, and migrant and seasonal farmworker status.