Background: To assess the extent of and characteristics associated with failure to return for HIV post-test counseling.

Methods: We conducted a retrospective cohort study including persons undergoing an HIV test during their visit to the Wake County, NC, STD clinic between January 1, 1995, and December 31, 2000. The study population included 101 newly diagnosed HIV positive subjects and 411 HIV negative subjects. The HIV negative subjects were randomly selected from persons undergoing testing in the 3-day periods surrounding the test date for each HIV positive subject. We conducted univariate and multivariate analyses to identify variables independently associated with returning for HIV post-test counseling.

Results: Of the 508 subjects (99%) with available records, 278 (55%) failed to return for their test results. In multivariate analysis, a history of failure to return for > 50% of previous HIV tests (OR 13.4, 95% CI, 5.4–33.0, p = < 0.001), and no previous HIV tests (OR 2.1, 95% CI, 1.2–3.8, p = 0.009), as compared to a history of returning for > 50% of previous HIV tests, were associated with failing to return for results. Other associated factors were protective, including diagnosis of HPV (OR 0.2, 95% CI, 0.1–0.7, p = 0.009), white race and non-white, non-black race (OR 0.6, 95% CI, 0.4–1.0, p = 0.038; OR 0.3, 95% CI, 0.2–0.7, p = 0.007, respectively; referent = black race), indicating a greater likelihood of returning for results. Of those clients testing HIV positive, 58 (58%) failed to return for results. Disease intervention specialists were successfully able to locate 51 of these clients (mean of 75 days ±176.3, Range 1–832 days). Seven (7) clients had no documentation of being found and notified of their positive results.

Conclusions: Return for HIV antibody test results among patients tested while seeking STD services are poor. We identified important variables associated with failure to return for HIV test results. For those clients testing positive who do not return, much time and effort is required to notify them of their results. To maximize the potential benefit of counseling and testing and to decrease this costly and pervasive problem, interventions need to be designed to target those at highest risk of not returning.