HIV screening guidelines more routine in hospitals
HIV screening guidelines more routine in hospitals
Workers can more easily learn of pathogen exposure
Major revisions to the CDC's guidelines for HIV screening will afford added protection for health care workers, with the recommendation that all hospital patients be tested unless they specifically decline.
The revised rules are a boon to the task of identifying the 250,000 Americans who carry the virus but don't know it, though some patient advocates say the recommendation is a blow to patient autonomy and privacy.
The CDC, in September, issued a new recommendation for across-the-board HIV testing for anyone age 13 to 64 as part of regular medical care. It removes requirements for written consent in states where consent is now mandatory, and eliminates the requirement for pre-test counseling.
"These recommendations come at a time when approximately 25 percent of the more than 1 million persons infected with HIV in this country are unaware of their infection," CDC Director Julie Gerberding, MD, stated in announcing the revised guidelines. "People who are infected but not aware of their condition are unable to take advantage of the therapies that can keep them healthy and extend their lives, or have the knowledge to protect their sex or drug-use partners from becoming infected. Knowing if one is HIV-infected or HIV-negative confers great benefits in healthy decision making."
Kevin Fenton, MD, director of the CDC's National Center for HIV, STD, and TB Prevention, says the new guidelines go a step further.
"Making the HIV test a normal part of care for all Americans is also an important step toward removing the stigma still associated with testing," Fenton suggests.
In some cases, health care workers still will encounter patients whose HIV status is not known or whose last HIV test was not recent. But those difficult situations will become rarer as patients are tested as a routine part of their hospital care.
A coalition of HIV and health care interests have issued objections to the new guidelines.
"An expanded focus on testing without counseling and written, informed consent will put people at risk for testing without their prior knowledge or approval," states an open letter issued by the coalition, which includes 33 AIDS -related groups, gay activists, and civil liberties organizations. The new guidelines, they say, are "a clear violation of medical ethics and human rights."
The coalition's letter expresses support for expanded testing, but strongly urges that counseling and written consent prior to testing be kept intact.
Revisions broaden testing, but keep it voluntary
The guideline changes are the result of study and debate over the last three years, and apply only to health care settings. They do not apply to outreach programs or community centers.
The major features of the recommendations include:
- "screening of all patients for HIV regardless of risk;
- "screening of high-risk persons at least once a year;
- "retention of a voluntary "opt-out" option for anyone who objects to being tested;
- "elimination of special consent; general medical consent will be considered sufficient to cover consent for HIV screening;
"HIV screening should be included in routine prenatal screening tests for all pregnant women, with repeat testing in the third trimester for women in certain areas where rates of HIV infection among pregnant women is high; "pre-test counseling and post-results counseling are recommended, but not required.
The guidelines ask that everyone in age 13 to 64 be tested at least once. The government estimates that one-quarter of people in the United States with HIV, about 250,000, do not know they are infected, and so do not seek treatment or ensure that they engage in safer-sex practices.
While many health care organizations, including the American Medical Association, have indicated support for the guideline changes as a prevention tool and means of eliminating some of the stigma associated with HIV testing, other groups are concerned by the changes.
"The CDC should be commended for trying to increase the number of people tested for HIV, but eliminating the only safeguards that guarantee that testing is voluntary and informed does little to ensure that people will receive the care they need," says Rose Saxe, JD, a staff attorney with the American Civil Liberties Union (ACLU) AIDS Project. "Studies have shown that patients who are tested without consent are less likely to get the follow-up care that is critical to maintaining good health."
The previous HIV testing guidelines had been issued in 1993, before HAART therapy (highly active antiretroviral therapy) altered the treatment and course of disease in HIV patients. According to the CDC, by prolonging lives and preserving health in HIV-infected people, HAART has helped eliminate some of the stigma associated with infection.
With routine testing, a health care worker's exposure still may involve someone whose HIV test was not recent. Clinicians and health care workers can call the National HIV/AIDS Clinicians' Consultation Center at the University of California in San Francisco, which runs the PEPLine (Post- Exposure Prophylaxis Hotline) for advice about post-exposure treatment (888) 448-4911. The PEPLine is available 24 hours a day, seven days a week.
The full report of the CDC's recommended HIV guidelines are available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm
Major revisions to the CDC's guidelines for HIV screening will afford added protection for health care workers, with the recommendation that all hospital patients be tested unless they specifically decline.Subscribe Now for Access
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