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Targeted HIV Testing Strategies May Be Key to Reaching Youths at Highest Risk of Infection


While HIV does not often get the attention that it used to in the United States, it is still an infection of serious concern, especially to youth. More than half of HIV-infected youth are not aware of whether they are infected, and therefore are not receiving the appropriate prevention or care from the health care system.

Much can be done to prevent people from contracting the virus, and much can now be done to care for those who are infected. Improved approaches to promote HIV testing among youths at risk is necessary, however.

A group of researchers, including IU School of Medicine’s Dennis Fortenberry, MD, recently evaluated a multi-site HIV testing program that was developed to improve testing among self-identified sexual minority males and to then link them to appropriate services after their results were available. Their findings were published in the June issue of JAMA Pediatrics.

Sexual minority males included those who identified as gay or bisexual. Unfortunately, these men are often missed by screening programs even though they may be at increased risk for infection.

Between June 2015 and February 2016, various testing strategies were evaluated through observation, without intervention. Then, new strategies were implemented by 12 adolescent medicine HIV primary care programs throughout the U.S. These strategies included target testing for those at increased risk, universal testing of everyone and a combination of both. The main outcomes of interest included the proportion of sexual minority males and sexual minority males of color tested, as well as the proportion of previously undiagnosed HIV-positive youths and the percentage linked to prevention services.

More than 3,300 youths underwent testing during the study period. Of those who went through universal testing, 3.6 percent were sexual minority males. In targeted testing programs, however, 46.7 percent were sexual minority males. In programs that used a combination of universal and targeted testing, 37.8 percent were sexual minority males.

Rates of infection detection also differed by program. In universal programs, 0.1 percent of tests identified new HIV-positive cases, compared to 2.1 percent in combination programs and 3.2 percent in targeted programs. When the researchers separated out the universal from the targeted components in combination programs, though, the rates of identification in universal programs dropped to 0.1 percent and those in targeted programs rose to 6.3 percent.

In addition, youths in targeted programs were linked successfully to prevention services more than 85 percent of the time, versus less than 35 percent of those who underwent testing in universal programs.

This study lends credence to the idea that community-based targeted approaches to HIV testing are more likely to be successful than universal programs. They are more likely to reach sexual minority males, to identify infected individuals and to connect uninfected individuals with prevention programs. Such programs are scalable and more likely to reach youth of color as well. This important work deserves more attention from policymakers and public health officials.

This research was funded by the National Institutes of Health through the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with supplemental funding from the National Institute on Drug Abuse, the National Institute on Mental Health and the National Institute on Minority Health and Health Disparities.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.

Aaron Carroll

Professor of Pediatrics

Dr. Carroll is a Professor of Pediatrics and Associate Dean for Research Mentoring at Indiana University School of Medicine, where he is also Director of the Center for Pediatric and Adolescent Comparative Effectiveness Research. His research focuses on ...