Friday, September 22, 2006

CDC Recommends Routine HIV Testing

The Centers for Disease Control and Prevention has released "Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings," which includes the following major revisions to previous guidelines:
For patients in all health-care settings
  • HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
  • Persons at high risk for HIV infection should be screened for HIV at least annually.
  • Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
  • Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings.

    For pregnant women
  • HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.
  • HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
  • Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
  • Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women.
  • These recommendations are not requirements, but are likely to influence healthcare providers. The rationale for the update includes the following points (see the link above for refs):
  • The annual number of AIDS cases and deaths declined substantially after 1994 but stabilized during 1999--2004 (1). However, since 1994, the annual number of cases among blacks, members of other racial/ethnic minority populations, and persons exposed through heterosexual contact has increased.
  • By 2002, an estimated 38%--44% of all adults in the United States had been tested for HIV; 16--22 million persons aged 18--64 years are tested annually for HIV (3). However, at the end of 2003, of the approximately 1.0--1.2 million persons estimated to be living with HIV in the United States, an estimated one quarter (252,000--312,000 persons) were unaware of their infection and therefore unable to benefit from clinical care to reduce morbidity and mortality (4). A number of these persons are likely to have transmitted HIV unknowingly (5).
  • HIV infection is consistent with all generally accepted criteria that justify screening: 1) HIV infection is a serious health disorder that can be diagnosed before symptoms develop; 2) HIV can be detected by reliable, inexpensive, and noninvasive screening tests; 3) infected patients have years of life to gain if treatment is initiated early, before symptoms develop; and 4) the costs of screening are reasonable in relation to the anticipated benefits (30). Among pregnant women, screening has proven substantially more effective than risk-based testing for detecting unsuspected maternal HIV infection and preventing perinatal transmission (31--33).
  • The 2005 Youth Risk Behavior Survey indicated that 47% of high school students reported that they had had sexual intercourse at least once, and 37% of sexually active students had not used a condom during their most recent act of sexual intercourse (76). More than half of all HIV-infected adolescents are estimated not to have been tested and are unaware of their infection (77,78).
  • Recent studies demonstrate that voluntary HIV screening is cost-effective even in health-care settings in which HIV prevalence is low (26,27,86).
  • Perinatal HIV transmission continues to occur, primarily among women who lack prenatal care or who were not offered voluntary HIV counseling and testing during pregnancy. A substantial proportion of the estimated 144--236 perinatal HIV infections in the United States each year can be attributed to the lack of timely HIV testing and treatment of pregnant women (102). Multiple barriers to HIV testing have been identified, including language barriers; late entry into prenatal care; health-care providers' perceptions that their patients are at low risk for HIV; lack of time for counseling and testing, particularly for rapid testing during labor and delivery; and state regulations requiring counseling and separate informed consent (103).
  • Other Resources:
  • U.S. Urges H.I.V. Tests for Adults and Teenagers - New York Times
  • U.S. Recommends Routine Testing For the AIDS Virus
  • CDC Recommends Routine AIDS Screening - NPR's All Things Considered
  • Initial Results From Washington, D.C., HIV Testing Program Show City's HIV Prevalence More Than Twice National Average - Medical News Today (thanks to BeckyJ for this and the previous link) and related, City Tests Reveal Infection Rate Double the U.S. Average, regarding DC's mass testing program
  • HIV Antibody Testing - Lab Tests Online
  • Women and HIV/AIDS - National Women's Health Information Center
  • HIV and AIDS - KidsHealth.org
  • General HIV/AIDS Information (for patients/general public) - AIDSinfo
  • 1 Comments:

    Blogger BeckyJ said...

    Joseph Shapiro of NPR covered this too, and included some commentary from a clinic in Washington DC where testing is already routine (also has been recent news coverage about the higher-than-expected HIV-positive results in DC).

    10:31 AM  

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