HIV testing increases, but more is needed

Two years after the government implemented routine HIV testing for all patients ages 13-64 without regard to risk, public health officials say improvements have been made, yet still one in five people infected with the AIDS virus is unaware of his/her status.1

"With HIV, ignorance is not bliss; those who are unaware of their infection cannot seek treatment and are at least three times more likely to transmit the virus," says Veronica Miller, PhD, director of the Washington, DC-based Forum for Collaborative HIV Research. "Two years after the Centers for Disease Control and Prevention [CDC] recommended routine testing, initial successes show its potentially powerful impact, but major barriers keep it from being the national norm."

The forum, an independent public-private partnership designed to facilitate discussion on emerging issues in HIV research, convened the 2008 National Summit on HIV Diagnosis, Prevention, and Access to Care in Arlington, VA. Summit partners included the HIV Medicine Association in Arlington, VA; the CDC in Atlanta; Office of AIDS Research in Bethesda, MD; Kaiser Permanente in Oakland, CA; Human Resources and Services Administration in Rockville, MD; and the American Academy of HIV Medicine, National Black Gay Men's Advocacy Coalition, and Veterans Affairs (VA), all based in Washington, DC.

Some 300 HIV researchers, health care providers, and policy-makers gathered at the summit to share new data on the advances and barriers to early, routine HIV testing, which is considered a key to slowing the U.S. epidemic, which now encompasses more than 1.1 million Americans living with HIV.1

Numerous examples of progress toward HIV screening in health care settings have been noted since the release of the CDC's recommendations in Septembe, 2006, reports Bernard Branson, MD, associate director for laboratory diagnostics in the Divisions of HIV/AIDS Prevention in the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

The recommendations for routine screening without regard to risk also have been adopted by several professional organizations, including the American College of Obstetricians and Gynecologists (ACOG) in August 2008 and, most recently, the American College of Physicians in December 2008, he says.2,3

Many public health officials have taken steps to expand HIV screening, says Branson. Numerous localities and facilities have implemented testing initiatives, such as citywide testing initiatives in New York City and Washington, DC, to routine testing in emergency departments and health systems across the nation, he states.4

Several states have changed or are changing laws to allow for routine testing, Branson notes. Since 2006, 11 states have removed requirements for separate written consent, states Branson. They are: Arizona, California, Iowa, Illinois, Indiana, Louisiana, Maine, Maryland, New Hampshire, New Mexico, and North Carolina. (Editor's note: To check your state's requirements, visit the web site for the National HIV/AIDS Clinicians' Consultation Center, www.nccc.ucsf.edu. Under "Featured Highlights," click on "Updated Compendium of State HIV Testing Laws.")

A recent nationwide study of VA hospitals showed that fewer than 10% of inpatients and fewer than 5% of outpatients were tested during the year ending Sept. 30, 2006. Look to see VA testing numbers change: In October 2008, Congress passed and President Bush signed into law a repeal of an earlier prohibition of widespread HIV testing programs and requirements for separate written consent in the VA health system, says Branson. The VA is working to revise its internal guidelines, according to information presented at the 2008 summit.5

Progress is being made on the reimbursement front, reports Branson. An increasing number of insurers provide reimbursement for HIV screening, and a recent California law requires that all health insurers in that state must pay for HIV screening, he states.

"While more work remains to be done, we are encouraged by the progress that we have seen to date," states Branson.

References

  1. Centers for Disease Control and Prevention (CDC). HIV prevalence estimates — United States, 2006. MMWR 2008; 57:1,073-1,076.
  2. American College of Obstetricians and Gynecologists. ACOG committee opinion. Routine human immunodeficiency virus screening. Obstet Gynecol 2008; 112 (2 Pt 1):401-403.
  3. Qaseem A, Snow V, Shekelle P, et al. Screening for HIV in health care settings: A guidance statement from the American College of Physicians and HIV Medicine Association. Ann Intern Med 2008; Nov 30. [Epub ahead of print.]
  4. Branson BM. Overview of routine/expanded HIV testing in the U.S. Presented at the 2008 National Summit on HIV Diagnosis, Prevention, and Access to Care. Arlington, VA; November 2008.
  5. Valdiserri RO, Rodriguez F, Holodniy M. Frequency of HIV screening in the Veterans Health Administration: Implications for early diagnosis of HIV infection. AIDS Educ Prev 2008; 20:258-264.