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HIV Testing in HRSA-Funded Health Center Sites


Health center sites funded by HRSA provide primary health care to millions of patients each year and are critical to efforts to test patients for human immunodeficiency virus (HIV) and reduce its spread. Since 2006, the Centers for Disease Control and Prevention (CDC) has recommended routine HIV testing-i.e., that patients be tested as a routine part of care and be told they will be tested unless they decline. This approach aims to expand testing to a wider patient population and increase testing rates. We did this study to determine the extent to which HRSA funded sites adopted four practices that CDC recommended: (1) routine HIV testing of all patients 13-64 years of age; (2) not requiring prevention counseling for all patients; (3) gaining patient consent for the HIV test in the same way as for other screening and diagnostic tests; and (4) providing HIV tests as standard, opt-out tests.


We analyzed survey responses from 324 HRSA-funded sites; the results are projectable to the estimated population of 5,275 sites that provide primary care. We determined the extent to which sites adopted the four practices and how Federal recommendations influenced their written HIV testing policies. We also asked sites to describe factors that affected their adoption of these practices and their provision of HIV testing.


Health center sites have not fully adopted all four practices recommended by CDC for routine HIV testing. Regarding whom to test, for which CDC's recommendation varies according to the circumstances of individual health care providers, 20 percent of sites reported testing all patients 13-64 years of age; 1 percent tested all adults, but not teens; and 55 percent targeted testing to high-risk patients. Regarding the other three practices, 29 percent adopted the practice regarding prevention counseling; 27 percent adopted the practice regarding gaining patient consent for the HIV test; and 15 percent adopted the practice regarding providing HIV tests as standard, opt-out tests. Most sites had written HIV testing policies that were influenced by the recommendation. Factors that affected adoption of the practices and affected HIV testing at sites included the financial resources of sites and patients, existence of partnerships with other community organizations, patient and staff perceptions about patient risk of contracting HIV, and patient discomfort associated with HIV testing.


We recommend that HRSA require grantees to establish and report to HRSA two HIV testing metrics: prevalence and positivity, as follows: (1) grantees should establish and report the prevalence of undiagnosed HIV among their patient populations, and (2) grantees should report HIV positivity (the proportion of patients who test positive among all those tested). We also recommend that HRSA continue to provide guidance and education to grantees and sites regarding the CDC-recommended practices and HIV testing. HRSA concurred with our recommendations and described its activities to improve HIV testing in sites.