New approaches to expanding HIV testing

Nearly 300 U.S. physicians, government health officials and HIV/AIDS advocates on Wednesday gathered in Washington, D.C., for a two-day meeting that focuses on new approaches to expanding HIV testing in the nation and its potential effect on the health system, Reuters Health reports.

The meeting, sponsored by CDC and titled “Opportunities for Improving HIV Diagnosis, Prevention and Access to Care in the U.S.,” also is addressing how the health care system will be affected over the long-term by increasing numbers of HIV diagnoses.

The rate of new HIV infections “has not changed in 16 years despite such great progress in other facets of the disease,” John Bartlett of Johns Hopkins University School of Medicine, and a co-chair of the meeting, said, adding that about 40,000 new HIV cases are reported annually. “Equally troubling” is the fact that about 250,000 HIV-positive people in the U.S. are unaware of their status and “are not benefiting from life-extending treatments and may unknowingly be transmitting HIV to other people,” according to Bartlett. Summit co-chair Kenneth Mayer of Brown University said eradicating HIV/AIDS in the U.S. will require increasing HIV testing, prevention and treatment. He noted that HIV screening rates remain low in physician offices, emergency departments, and sexually transmitted infection and family planning clinics. “If voluntary, routine HIV testing is to become a reality in doctors’ offices, emergency rooms and other health care settings around the country, we need to address a number of social, economic and logistical issues,” Mayer said. According to a recent study, more than 60% of people who were newly diagnosed with HIV/AIDS and who have regular access to health care were in an advanced stage of the disease upon diagnosis. This indicates that earlier opportunities for diagnosis were missed, Reuters Health reports.

Experts Say Routine HIV Testing Worth High Costs
Health officials at the meeting also said universal, routine HIV testing as recommended by CDC likely will cost the U.S. health care system $900 million annually; however, the expenditures will prove worthwhile in terms of lives and money saved over the long-term (Fox, Reuters, 11/29). CDC’s recommendations, published in the Sept. 22 edition of CDC’s Morbidity and Mortality Weekly Report, say that voluntary HIV testing should become a routine part of medical care for people ages 13 to 64. In addition, they say that care providers should continue routine HIV testing unless they establish that fewer than one of every 1,000 patients tested is HIV-positive, “at which point such screening is no longer warranted.” Providers do not have to require patients to sign separate written consent forms or undergo counseling before receiving an HIV test, but physicians must allow patients to opt out of the test, according to the guidelines. The recommendations - which states can choose to adopt and modify - also say that all pregnant women should be tested for the virus unless they opt out and that women who are injection drug users, are commercial sex workers or who live in a higher prevalence region should be tested again in the third trimester of pregnancy (Kaiser Daily HIV/AIDS Report, 10/10). David Holtgrave, a Johns Hopkins Bloomberg School of Public Health professor, said routine testing could lead to 56,000 new HIV/AIDS cases being diagnosed next year. Much of the added federal expense associated with an HIV-positive diagnosis, which is estimated at $20,000 per HIV-positive person annually, would go toward providing no-cost antiretroviral treatment and HIV counseling for those who are uninsured, the Baltimore Sun reports. In addition, the government might have to spend an additional $1 billion to prevent lengthy waiting lists for antiretrovirals, according to meeting participants. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, “The idea of making testing a routine part of medical care is clearly the thing to do, so long as we make sure to accompany that with care, treatment and counseling” (Bor, Baltimore Sun, 11/30).

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Revision date: June 20, 2011
Last revised: by Jorge P. Ribeiro, MD