Healthcare utilization as a predictor of in-pharmacy HIV testing

Background: Patterns of healthcare utilization among Black and Latinos differ when compared to whites. Financial reasons partially explain these differences. Latinos tend to have lower utilization rates regardless of... [ view full abstract ]

Background: Patterns of healthcare utilization among Black and Latinos differ when compared to whites. Financial reasons partially explain these differences. Latinos tend to have lower utilization rates regardless of insurance status. Blacks tend to be insured, but face other barriers to care and utilization of health services. The Expanded Syringe Access Program (ESAP) in pharmacies may provide an alternative way to access healthcare in Black/Latino communities at risk for HIV. Pharmacies may be positioned to provide in-pharmacy HIV testing and linkage to healthcare services in at-risk communities.

Objective: To examine the role of healthcare utilization as a predictor of in-pharmacy HIV testing in neighborhoods with high HIV prevalence.

Methods: We examined the associations between healthcare utilization and in-pharmacy HIV testing among a racially/ethnically diverse sample of participants (n=233). Data for this analysis come from a cross-sectional study among customers in ESAP pharmacies in Harlem, NYC (2010-2011). Binary logistic regression models were constructed to examine the role of healthcare utilization as a predictor of the likelihood of undergoing in-pharmacy HIV testing. A composite healthcare utilization score was computed to further explore this relationship.

Results: Most participants were male (55%), black (80%), and had used hard drugs (88%); 39.5% received in-pharmacy HIV testing. The majority had health insurance (93%), access to a healthcare provider (79%), and continuity of care (77%). Bivariable analysis indicated that lacking access to a healthcare provider and lower levels of continuity of care were associated with an increased likelihood of accepting in-pharmacy HIV testing. Lower levels of healthcare utilization increased the likelihood of undergoing in-pharmacy HIV testing by 70%.

Conclusions: Findings suggest that pharmacies could reach those who are not accessing traditional healthcare for HIV testing. In-pharmacy HIV testing may be a useful complement to healthcare-based testing. Further research must explore the implementation of this HIV prevention strategy.