Studies Prove Value of Voluntary HIV Testing in Health Care Settings

Although many physicians are not up to speed onthe CDC 2006 recommendations on HIV screening,institution of routine voluntary testing inhealth care settings does enhance identification of undiagnosedcases of HIV infection. Furthermore, patients-especially those in high-risk groups-are generally receptiveto the opportunity to be screened for HIV infection.These were the findings from several studies on HIVtesting that were presented during a poster session at thejoint 48th Annual Interscience Conference on AntimicrobialAgents and Chemotherapy and 46th Annual Meetingof the Infectious Diseases Society of America, which tookplace in Washington, DC, from October 25 to 28, 2008.

Findings from a survey of residents in internal medicine(N = 450) from 15 participating residency programsin New York City revealed that 67% of respondents wereunaware of the current guidelines.¹ Most respondents(64%) performed 10 or fewer HIV screening tests withinthe past 6 months, and only 35.8% of respondents used aroutine screening approach. Not surprisingly, those whowere aware of the current CDC guidelines were morelikely to perform routine screening tests.

Another study conducted at the Chicago Medical Centerthat analyzed 4.5 years (January 2003 to July 2007) ofdata from billing records and chart reviews found nochange in the rate of screening after the CDC guidelineswere issued. Furthermore, overall inefficiency in screeningfor lack of a systematized approach resulted in inappropriateor unnecessary repeated testing of patients and,conversely, in missed opportunities for testing of otherpatients who would have benefited from earlier identificationof HIV status.²

Meanwhile, the rate of voluntary HIV testing increased8-fold at the Veterans Administration MedicalCenter (VAMC) in Washington, DC, when it implementeda rapid HIV point-of-care testing program in whichall inpatients in the mental health and general medicalwards were offered rapid HIV testing regardless of riskstatus.³ Incidence of newly diagnosed HIV infectionsamong the patients who consented to HIV testing was1%, satisfying the criterion for cost-effectiveness forscreening established by the CDC.

In addition, a study conducted in Detroit that lookedat acceptance levels of voluntary HIV testing found thatconsent was high-with an overall rate of 69%.⁴ Youngerpersons (mean age, 41 vs 44 years) were more likely toconsent to testing, as were African American persons,compared with white persons (74.1% vs 53.5%), suggestingthat different strategies might be needed to overcomebarriers to screening in certain population groups.

To analyze the value of inpatient screening in accordancewith the CDC guidelines, investigators de-identifiedand then tested blood samples from inpatients andoutpatients at a large tertiary-care referral center in Allentown,Pa.⁵ Nine cases of HIV infection were confirmed.Seven (78%) of these cases were diagnosed basedon blood samples from inpatients, suggesting that theprevalence of HIV infection is significantly higher amonginpatients than among the general population. The rate ofinpatient HIV positivity was 1.75%, suggesting that routinevoluntary HIV testing of all persons who accesshealth care, as recommended by the CDC, would be veryeffective in identifying new cases of infection.

References:

• Jain CL, Wyatt C, Burke R, et al. HIV testing practices and diffusion of 2006 CDC HIV testing recommendations among New York City internal medicine residents. Poster presented at: 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/46th Annual Meeting of the Infectious Diseases Society of America; October 25-28, 2008; Washington, DC.

• Schrantz SJ Jr, Bares S, Pouch S, et al. Retrospective analysis of HIV testing at a large, urban medical center: support for increased non-targeted testing. Poster presented at: 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/46th Annual Meeting of the Infectious Diseases Society of America; October 25-28, 2008; Washington, DC.

• Siegel M, Kennedy L, Mishra S, et al. Inpatient HIV point-of-care (HIV-POC) testing. Poster presented at: 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/46th Annual Meeting of the Infectious Diseases Society of America; October 25-28, 2008; Washington, DC.

• Mehta T, Valenti S, Szpunar SM, Johnson LB. Effect of age and race on willingness for rapid HIV testing. Poster presented at: 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/46th Annual Meeting of the Infectious Diseases Society of America; October 25-28, 2008; Washington, DC.

• Hoffman-Terry ML, Ahmed KN, Yozviak J, et al. Answering the CDC's call for universal HIV testing: assessing the impact on a tertiary care referral center via a blinded seroprevalence study. Poster presented at: 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/46th Annual Meeting of the Infectious Diseases Society of America; October 25-28, 2008; Washington, DC.