CDC's HIV Testing Recommendations Not Being Followed

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Two years after CDC recommended routine HIV testing for people ages 13 to 64, several studies presented at a recent conference indicate that the recommendations generally are not being followed, the Washington Post reports (Brown, Washington Post, 11/21). According to the Baltimore Sun, researchers at the Forum for Collaborative HIV Research -- based at the George Washington University School of Public Health -- said on Thursday during the conference that HIV testing is a significant step to ending the epidemic in the U.S.

About 1.1 million people are living with HIV in the U.S. and one in five is unaware of his or her status. The researchers also said that people who are unaware that they are HIV-positive are responsible for transmitting 50% to 70% of new sexually transmitted infection cases. John Bartlett, chief of infectious diseases at Johns Hopkins University School of Medicine and a co-chair of the meeting, said the high number of people unaware of their HIV status should be a "call to action that the test will be offered on a more regular basis" (Brewington, Baltimore Sun, 11/21).

According to the Post, the studies show that the most common reasons for not following CDC's recommendations are misconceptions by clinicians that the tests take too much time, as well as an unwillingness by health insurers to pay for the tests. Kevin Fenton -- director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention -- said, "Reimbursement is a major barrier to routine testing." The Post reports that testing a patient who receives an initial saliva test, followed by a blood test for confirmation if possible, costs about $80 to $120 if the patient is charged (Washington Post, 11/21).

The Sun also reports that a continuing stigma associated with HIV/AIDS is contributing to a lack of widespread testing. Richard Rothman, associate professor in Johns Hopkins University's Department of Emergency Medicine, said 2006 data show that emergency departments tested patients at a rate of 3.2 tests per 1,000 visits. "There are many missed opportunities in recognizing patients earlier in the course of their illness," he said (Baltimore Sun, 11/21).

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Veronica Miller, executive director of the forum, said that HIV/AIDS is a "life-threatening disease that is so grossly underdiagnosed and undertreated in this country." She said that about 5% of patients presenting with serious illness are routinely tested for HIV in hospital EDs. For example, at John H. Stroger Jr. Hospital of Cook County in Chicago, about 2,000 people who went to the ED and were ill enough to be admitted were offered HIV tests. Slightly less than 1% tested HIV-positive, and more than 90% had CD4+ T cell counts less than 200, one of the factors that leads to an AIDS diagnosis (Washington Post, 11/21).

According to the AP/Indianapolis Star, 11 states have changed their laws to no longer require special consent for HIV testing, which is a "key step to making an HIV test part of the standard battery that patients expect." People living with HIV are "mostly likely" to be found in EDs because many are uninsured and have low incomes, the AP/Star reports. Bartlett said that routine HIV testing in patients who are not critically ill is given in no more than 100 of the U.S.'s 5,000 EDs, adding that about 40% of pregnant women and their infants who should be tested for HIV are not. "Those are what we call missed opportunities," he said (Neergaard, AP/Indianapolis Star, 11/20).

The studies also show that if routine HIV testing were implemented in the U.S., HIV detection could occur at earlier stages in many people (Washington Post, 11/21). Miller said that it is "crucial to understand how important routine HIV testing is at every level of American society so everyone knows their status; it's the first step in controlling the HIV epidemic" (Tasker, Miami Herald, 11/20). Bartlett said HIV testing today is "much better, it's much easier, it's much cheaper. The treatment is really great now." CDC's Bernard Branson said the agency "find[s] people are very receptive to being tested, and there was concern about that before."

He added that "people are taking the recommendations to heart and implementing them as much as was feasible for them." According to the AP/Star, data from the studies presented on Thursday indicate that more than 80% of ED patients were "amenable" to HIV tests and that most ED staff were opposed to administering the tests. This is "[p]resumably because [EDs] are so busy, and there is confusion on how much HIV counseling is needed," the AP/Star reports. There are no nationwide data on the impact of the new guidelines, according to Branson (AP/Indianapolis Star, 11/20).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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