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Objective: To investigate opportunities for early human immunodeficiency virus (HIV) testing on women.

Methods: A retrospective cohort study design linked case reports from HIV surveillance to several statewide health-care databases. Medical encounters occurring before the first positive HIV test (missed opportunities) were categorized by diagnosis/procedure codes to distinguish visits that were likely to have prompted an HIV test. Women were categorized as late testers (AIDS diagnosis < 12 months from first HIV test date), non-late testers (no AIDS diagnosis during study period or diagnosis of AIDS > 12 months of HIV diagnosis), of reproductive age (13-44 years old), and not of reproductive age (> 44 years old). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to estimate risk and its statistical significance.

Results: Of 3303 HIV-infected women diagnosed during the study period, 2408 (73%) had missed opportunity visits. Late testers (39%) were more likely to be black than white (aOR 1.48, 95% CI 1.12-1.95), be older (> 44 years old; aOR 7.85, 95% CI 4.49-13.7), and have > 10 missed opportunity visits (aOR 2.17, 95% CI 1.62-2.91). Fifty-four percent of women > 44 years old were also late testers. Women > 44 years old had lower median initial CD4 counts (p 44 years old and Papanicolau smear was ranked fourth for late testers.

Conclusions: Feasibility and acceptability of routine HIV testing in nontraditional health-care settings, such as mammography and Papanicolau screenings, should be explored to identify late testers and older (not of reproductive age) HIV-infected women.


Duffus, W. A., Davis, H. T., Byrd, M. D., Heidari, K., Stephens, T. G., & Gibson, J. J. (2012). HIV testing in women: Missed opportunities. Journal of Women's Health, 21(2), 170-178.

DOI: 10.1089/jwh.2010.2655

© Journal of Women's Health, 2012, Mary Ann Liebert, Inc.

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