Special Report on Prevention Initiatives

CDC’s prevention initiative shows no testing increase

Various demonstration projects funded

Officials with the Centers for Disease Control and Prevention (CDC) expect to see some results from the HIV Prevention Initiative in 2004, although the data remain to be analyzed and the 2003 data demonstrated no impact.

Launched in April 2003, the initiative’s main objective was to increase the number of people who are aware of their HIV serostatus and to bring prevention messages to them, says Robert Janssen, MD, director of divisions of HIV/AIDS prevention — surveillance and epidemiology support at the CDC.

"I think the major and most visible thing that’s happened is supporting the implementation of rapid HIV testing in our programs, whether in health clinics we fund or in community outreach," he says. "We’ve done a bit to increase access to testing for HIV, but we don’t have [2004] data yet."

The 2003 data showed that the total number of HIV tests conducted in 2003 was the same as for 2002, and the total number of HIV-positive tests identified in 2003 was the same as for 2002, Janssen explains.

"But the demonstration projects weren’t funded until late in 2003, and so wouldn’t be felt in the data," he says.

Janssen also notes that more rapid HIV tests are being used, but in some instances, they are being used rather than enzyme immunoassays. "So we wouldn’t necessarily see an increase in testing if that’s going on," he adds.

The CDC primarily is focusing on bringing HIV rapid testing to areas where there might be a large number of people who are unaware they are HIV-positive, Janssen says.

"So we may not necessarily see an increase in testing, but what we want to do is try to increase the proportion of positive tests," he notes.

For example, HIV testing in correctional facilities has resulted in finding high prevalence of positive HIV tests when compared to the general population, Janssen says.

The 2004 data, which Janssen expects will show an increase in testing, will not be available for analysis until later in 2005.

"We’ve heard from a number of areas that people at high risk for HIV are coming in to get tested," he says. "They’ve heard about the availability of the rapid test and want to get that test."

The state of New York has reported that one-third of the people who have been tested with the rapid HIV test had never been tested before and said they wouldn’t use any other test, Janssen adds.

The hope, he says, is that the rapid HIV test will attract people who have never been tested before, including people who might not go to their provider or medical clinic office to get tested.

The CDC-funded demonstration projects, costing $23 million in 2003, are meant to be models for testing and are intended to find high-risk populations, Janssen notes.

Expanded testing

For example, one demonstration project supports the routine offering of HIV testing in an emergency department setting; another provides HIV testing in short-stay correctional facilities, where the rapid test works best for people who may only be in the facility for a few days, he says.

One of the things that federal officials are concerned about involves HIV-positive individuals who are not in treatment for their disease and who often progress to AIDS-defining illnesses before they are diagnosed and/or routinely treated, Janssen says.

From 2000-2003 data, the CDC found that 37% of people who were diagnosed with HIV were also diagnosed with AIDS at the same time, he says.

"So they clearly were infected from three to 15 years and were just now being diagnosed with HIV and AIDS at the same time," Janssen adds.

So by pushing for increased rapid HIV testing in communities in which there are large at-risk populations, CDC officials hope to catch these HIV-infected individuals earlier in their infection and to get them into treatment before they develop AIDS, he continues.

"Our funding of CBOs is to work with medical providers as they do outreach into the community to identify people who are infected and to link them back into medical services," Janssen says.

Another project involves providing rapid testing in conjunction with partner notification and referral and counseling services. That allows those partners to be tested on the spot.

Janssen also notes that a social network approach is being used. In it, someone who is HIV-positive is asked about friends he or she thinks might be positive or exposed to HIV so they can be tested, he says.

"In that study, we’re finding the prevalence of new HIV diagnoses is 6%, while what we’re seeing in the national counseling and testing system of 2 million tests per year is a 1.4% prevalence of positive tests."

This social network approach appears to be doing an efficient job of identifying people with HIV who do not know their serostatus, he says.

"It’s being tested in more than one location, and we’re funding community-based organizations to do it," Janssen says.

"We have had, in some areas, anecdotal reports that the numbers of people tested has increased and that the number of people testing positive has increased," he notes.

The CDC has not heard any reports that communities are having difficulty providing resources to the people who have tested positive, although this has been a concern among AIDS advocacy groups.

"We have not heard specific concerns that people have not been able to get into services once they’ve tested positive," Janssen adds.