To determine HIV testing trends during emergency department (ED) visits among those with and without substance use disorder (SUD) and examine factors associated with test receipt.

We identified individuals age ≥ 15 with an ED visit between 2014 and 2018 in the National Hospital Ambulatory Medical Care Survey (NHAMCS), a representative sample of United States ED visits. We examined HIV testing trends by SUD status and used multivariable logistic regression accounting for NHAMCS's complex survey design to identify factors associated with HIV testing.

We identified 6399 SUD and 75,498 non-SUD ED visits. Of SUD visits, 1.4% [95% Confidence Interval (95%CI 0.9–1.9)] resulted in HIV testing compared to 0.6% (95%CI 0.4–0.7) of non-SUD visits. During the second half of the study (Q3, 2016 - Q4, 2018), HIV testing increased from 1.1% (95%CI 0.6–1.6) to 1.7% (95%CI 1.0–2.5) among those with SUD and from 0.5% (95%CI 0.3–0.6) to 0.6% (95%CI 0.5–0.8) among those without SUD. In adjusted models, SUD status was associated with increased odds of HIV testing [Adjusted Odds Ratio (AOR) 1.6 (95%CI 1.1–2.2)]. Those receiving toxicology testing (AOR 2.2, 95%CI 1.6–3.2), Black (AOR 3.6, 95%CI 2.6–4.9) and Hispanic people (AOR 2.7, 95%CI 1.9–3.7), insured by Medicaid (AOR 1.6, 95%CI 1.2–2.2) or self-pay (AOR 1.7, 95%CI 1.1–2.8), and with venipuncture (AOR 3.0, 95%CI 2.2–4.1) also had greater odds of HIV testing.

HIV testing in the ED was rare, but slightly more common in individuals with SUD. Efforts to increase ED HIV testing among people with SUD are needed.