Skip to main content

Advertisement

Log in

Implications and impact of the new US centers for disease control and prevention HIV testing guidelines

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Of the 1.2 million Americans estimated to be living with HIV in the United States, approximately 250,000 are unaware of their diagnosis and therefore unable to access clinical care and life-sustaining treatment. The revised 2006 US Centers for Disease Control and Prevention’s guidelines for HIV testing recommend universal, routine, and voluntary HIV screening in public and private health care settings for all adults and adolescents between 13 and 64 years old. These major revisions present new challenges for health care providers, hospitals, government agencies, and community advocacy groups. In this review, we discuss the important issues in diverse care venues such as opt-out testing, consent and confidentiality, barriers to treatment, and financial impact. The implications of the revised recommendations for HIV testing are addressed in the context of a fragmented, overstressed, underfunded US health care system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. CDC: Revised recommendation for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Morb Mortal Wkly Rep 2006, 55:1–17.

    Google Scholar 

  2. Glynn M: Estimated HIV prevalence in the United States at the end of 2003. Presented at the 2005 National HIV Prevention Conference. Atlanta, Georgia; June 12–15, 2005.

  3. CDC: Epidemiology of HIV/AIDS—United States, 1981–2005. MMWR Morb Mortal Wkly Rep 2006, 55:589–592.

    Google Scholar 

  4. CDC: Racial/ethnic disparities in diagnoses of HIV/AIDS—33 states, 2001–2005. MMWR Morb Mortal Wkly Rep 2007, 56:189–193.

    Google Scholar 

  5. Holmberg SD, Palella Jr FJ, Lichtenstein KA, Havlir DV: The case for earlier treatment of HIV infection. Clin Infect Dis 2004, 39:1699–1704.

    Article  PubMed  Google Scholar 

  6. Walensky RP, Paltiel AD, Losina E, et al.: The survival benefits of AIDS treatment in the United States. J Infect Dis 2006, 194:11–19.

    Article  PubMed  Google Scholar 

  7. Marks G, Crepaz N, Janssen RS: Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 2006, 20:1447–1450.

    Article  PubMed  Google Scholar 

  8. CDC: Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings. MMWR Morb Mortal Wkly Rep 1993, 42:157–158.

    Google Scholar 

  9. CDC: Revised guidelines for HIV counseling, testing, and referral. MMWR Morb Mortal Wkly Rep 2001, 50:1–58.

    Google Scholar 

  10. Bozzette SA, Berry SH, Duan N, et al.: The care of HIV-infected adults in the United States. HIV Cost and Services Utilization Study Consortium. N Engl J Med 1998, 339:1897–1904.

    Article  PubMed  CAS  Google Scholar 

  11. Chen Z, Branson B, Ballenger A, Peterman TA: Risk assessment to improve targeting of HIV counseling and testing services for STD clinic patients. Sex Transm Dis 1998, 25:539–543.

    Article  PubMed  CAS  Google Scholar 

  12. CDC: HIV testing among pregnant women—United States and Canada, 1998–2001. MMWR Morb Mortal Wkly Rep 2002, 51:1013–1016.

    Google Scholar 

  13. CDC: Missed opportunities for earlier diagnosis of HIV infection—South Carolina, 1997–2005. MMWR Morb Mortal Wkly Rep 2006, 55:1269–1272.

    Google Scholar 

  14. United States Preventive Services Task Force: Screening for HIV: US Preventive Services Task Force recommendations. Ann Intern Med 2005, 143:1–30.

    Google Scholar 

  15. Chou R, Huffman L: Screening for human immunodeficiency virus: focused update of a 2005 systematic evidence review for the US Preventive Services Task Force. Available at http://www.ahrq.gov/clinic/uspstf07/hiv/hivrevup.pdf. Accessed December 21, 2007.

  16. Franco-Paredes C, Tellez I, del Rio C: Rapid HIV testing: a review of the literature and implications for the clinician. Curr HIV/AIDS Rep 2006, 3:169–175.

    Article  PubMed  Google Scholar 

  17. CDC: Notice to readers: protocols for confirmation of reactive rapid HIV tests. MMWR Morb Mortal Wkly Rep 2004, 53:221–222.

    Google Scholar 

  18. Silva A, Glick NR, Lyss SB, et al.: Implementing an HIV and sexually transmitted disease screening program in an emergency department. Ann Emerg Med 2007, 49:564–572.

    Article  PubMed  Google Scholar 

  19. Branson B: State of the art for HIV diagnosis. Presented at Opportunities for Improving HIV Diagnosis, Prevention, and Access to Care in the US. Washington DC; November 29, 2006.

  20. Tao G, Branson BM, Kassler WJ, Cohen RA: Rates of receiving HIV test results: data from the US National Health Interview Survey for 1994 and 1995. J Acquir Immune Defic Syndr 1999, 22:395–400.

    PubMed  CAS  Google Scholar 

  21. Walensky RP, Losina E, Malatesta L, et al.: Effective HIV case identification through routine HIV screening at urgent care centers in Massachusetts. Am J Public Health 2005, 95:71–73.

    Article  PubMed  Google Scholar 

  22. Burke RC, Sepkowitz KA, Bernstein KT, et al.: Why don’t physicians test for HIV? A review of the US literature. AIDS 2007, 21:1617–1624.

    Article  PubMed  Google Scholar 

  23. McKenna M: HIV testing: should the emergency department take part? Ann Emerg Med 2007, 49:190–192.

    Article  PubMed  Google Scholar 

  24. Arbelaez C, Losina E, Wright E, et al.: The barriers affecting health care provider’s willingness to perform routine HIV testing in the emergency department. Presented at the American College of Emergency Physicians Scientific Assembly. Seattle, WA; October 8–11, 2007.

  25. Hilton C, Sabundayo BP, Langan SJ, et al.: Screening for HIV infection in high-risk communities by urine antibody testing. J Acquir Immune Defic Syndr 2002, 31:416–421.

    PubMed  CAS  Google Scholar 

  26. Goggin M, Davidson A, Cantril S, et al.: The extent of undiagnosed HIV infection among emergency department patients: results of a blinded seroprevalance survey and a pilot HIV testing program. J Emerg Med 2000, 19:13–19.

    Article  PubMed  CAS  Google Scholar 

  27. Glick NR, Silva A, Zun L, Whitman S: HIV testing in a resource-poor urban emergency department. AIDS Educ Prev 2004, 16:126–136.

    Article  PubMed  Google Scholar 

  28. CDC: Rapid HIV testing in emergency departments—three U.S. sites, January 2005–March 2006. MMWR Morb Mortal Wkly Rep 2007, 56:597–601.

    Google Scholar 

  29. Wurcel A, Zaman T, Zhen S, Stone D: Acceptance of HIV antibody testing among inpatients and outpatients at a public health hospital: a study of rapid versus standard testing. AIDS Patient Care STDS 2005, 19:499–505.

    Article  PubMed  Google Scholar 

  30. Kushner M, Solorio MR: The STI and HIV testing practices of primary care providers. J Natl Med Assoc 2007, 99:258–263.

    PubMed  Google Scholar 

  31. Walensky RP, Losina E, Steger-Craven KA, Freedberg KA: Identifying undiagnosed human immunodeficiency virus: the yield of routine, voluntary inpatient testing. Arch Intern Med 2002, 162:887–892.

    Article  PubMed  Google Scholar 

  32. Lubelchek R, Kroc K, Hota B, et al.: The role of rapid vs conventional human immunodeficiency virus testing for inpatients: effects on quality of care. Arch Intern Med 2005, 165:1956–1960.

    Article  PubMed  Google Scholar 

  33. Hutchinson AB, Corbie-Smith G, Thomas SB, et al.: Understanding the patient’s perspective on rapid and routine HIV testing in an inner-city urgent care center. AIDS Educ Prev 2004, 16:101–114.

    Article  PubMed  Google Scholar 

  34. Annas GJ: Protecting patients from discrimination—the Americans with Disabilities Act and HIV infection. N Engl J Med 1998, 339:1255–1259.

    Article  PubMed  CAS  Google Scholar 

  35. HIV patient names to be tracked in all 50 states by year’s end. AIDS Read 2007, 17:238, 252.

  36. The Institute of Medicine of the National Academies: Measuring What Matters: Allocation, Planning and Quality Assessment for the Ryan White CARE Act. Washington, DC: The National Academies Press; 2004.

    Google Scholar 

  37. Kaiser Daily HIV/AIDS Report: All US states to begin names-based reporting of HIV cases by end of 2007. Available at http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=44011. Accessed December 27, 2007.

  38. Cargill VA, Stone VE: HIV/AIDS: a minority health issue. Med Clin North Am 2005, 89:895–912.

    Article  PubMed  Google Scholar 

  39. Samet JH, Freedberg KA, Savetsky JB, et al.: Understanding delay to medical care for HIV infection: the long-term nonpresenter. AIDS 2001, 15:77–85.

    Article  PubMed  CAS  Google Scholar 

  40. US Centers for Disease Control and Prevention: HIV counseling and testing in publicly funded sites: annual report 1997 and 1998. Available at http://www.cdc.gov/hiv/topics/testing/resources/reports/pdf/cts98.pdf. Accessed January 8, 2008.

  41. Mehta SD, Hall J, Lyss SB, et al.: Adult and pediatric emergency department sexually transmitted disease and HIV screening: programmatic overview and outcomes. Acad Emerg Med 2007, 14:250–258.

    Article  PubMed  Google Scholar 

  42. Anthony MN, Gardner L, Marks G, et al.: Factors associated with use of HIV primary care among persons recently diagnosed with HIV: examination of variables from the behavioural model of health-care utilization. AIDS Care 2007, 19:195–202.

    Article  PubMed  CAS  Google Scholar 

  43. Losina E: Disparities in survival attributable to suboptimal HIV care in the US: influence of gender and race/ethnicity. Presented at the Conference on Retroviruses and Opportunistic Infections. Los Angeles; February 25–28, 2007.

  44. Saag MS: Ensuring access to HIV care. Presented at Opportunities for Improving HIV Diagnosis, Prevention and Access to Care in the US. Washington, DC; November 30, 2006.

  45. Sanders GD, Bayoumi AM, Sundaram V, et al.: Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med 2005, 352:570–585.

    Article  PubMed  CAS  Google Scholar 

  46. The Henry J. Kaiser Family Foundation, the National Alliance of State and Territorial AIDS Directors (NASTAD): National ADAP Monitoring Project, Annual Report, April 2007. Available at http://www.nastad.org/Docs/highlight/2007411_2007NationalADAPMonitoringRepFINAL.pdf. Accessed December 27, 2007.

  47. Walensky RP, Paltiel AD, Freedberg KA: AIDS Drug Assistance Programs: highlighting inequities in human immunodeficiency virus-infection health care in the United States. Clin Infect Dis 2002, 35:606–610.

    Article  PubMed  Google Scholar 

  48. Presidential Advisory Council on HIV/AIDS: Achieving an HIV-free generation: recommendations for a new American HIV strategy. Available at http://www.pacha.gov/pdf/PACHArev113005.pdf. Accessed December 27, 2007.

  49. Lubinski C: Medicare/Medicaid. Presented at Opportunities for Improving HIV Diagnosis, Prevention and Access to Care in the US. Washington, DC; November 30, 2006.

  50. Horberg M: Ensuring access to care-The Kaiser Permanente experience. Presented at Opportunities for Improving HIV Diagnosis, Prevention and Access to Care in the US. Washington, DC; November 30, 2006.

  51. Holtgrave DR: Costs and consequences of the US Centers for Disease Control and Prevention’s recommendations for opt-out HIV testing. PLoS Med 2007, 4:e194.

    Article  PubMed  Google Scholar 

  52. Schackman BR, Gebo KA, Walensky RP, et al.: The lifetime cost of current human immunodeficiency virus care in the United States. Med Care 2006, 44:990–997.

    Article  PubMed  Google Scholar 

  53. Paltiel AD, Weinstein MC, Kimmel AD, et al.: Expanded screening for HIV in the United States—an analysis of cost-effectiveness. N Engl J Med 2005, 352:586–595.

    Article  PubMed  CAS  Google Scholar 

  54. Walensky RP, Weinstein MC, Kimmel AD, et al.: Routine human immunodeficiency virus testing: an economic evaluation of current guidelines. Am J Med 2005, 118:292–300.

    Article  PubMed  Google Scholar 

  55. Paltiel AD, Walensky RP, Schackman BR, et al.: Expanded HIV screening in the United States: effect on clinical outcomes, HIV transmission, and costs. Ann Intern Med 2006, 145:797–806.

    PubMed  Google Scholar 

  56. Hodge JG: Advancing HIV prevention initiative: a limited legal analysis of state HIV statutes. Initial assessment for the Centers for Disease Control and Prevention. Available at http://www.publichealthlaw.net/Research/PDF/AHP%20Report%20-%20Hodge.pdf. Accessed December 27, 2007.

  57. Zetola NM, Klausner JD, Haller B, et al.: Association between rates of HIV testing and elimination of written consents in San Francisco. JAMA 2007, 297:1061–1062.

    Article  PubMed  CAS  Google Scholar 

  58. Korner H: Late HIV diagnosis of people from culturally and linguistically diverse backgrounds in Sydney: the role of culture and community. AIDS Care 2007, 19:168–178.

    Article  PubMed  CAS  Google Scholar 

  59. Lansky A, Sansom SL, Harrison LL, Stancil T: Trends in prenatal discussion and HIV testing, 1996–2001: Pregnancy Risk Assessment Monitoring System. Matern Child Health J 2007, 11:526–531.

    Article  PubMed  Google Scholar 

  60. Liddicoat RV, Losina E, Kang M, et al.: Refusing HIV testing in an urgent care setting: results from the “Think HIV” program. AIDS Patient Care STDS 2006, 20:84–92.

    Article  PubMed  Google Scholar 

  61. Skolnik HS, Phillips KA, Binson D, Dilley JW: Deciding where and how to be tested for HIV: what matters most? J Acquir Immune Defic Syndr 2001, 27:292–300.

    PubMed  CAS  Google Scholar 

  62. Mugavero MJ, Lin HY, Allison JJ, et al.: Failure to establish HIV care: characterizing the “no show” phenomenon. Clin Infect Dis 2007, 451:127–130.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennifer C. Millen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Millen, J.C., Arbelaez, C. & Walensky, R.P. Implications and impact of the new US centers for disease control and prevention HIV testing guidelines. Curr Infect Dis Rep 10, 157–163 (2008). https://doi.org/10.1007/s11908-008-0027-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-008-0027-6

Keywords

Navigation