Elsevier

Mayo Clinic Proceedings

Volume 87, Issue 9, September 2012, Pages 915-924
Mayo Clinic Proceedings

Symposium on antimicrobial therapy
HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

https://doi.org/10.1016/j.mayocp.2012.06.021Get rights and content

Abstract

Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.

Section snippets

HIV Testing in the United States

In 1985, when the US Food and Drug Administration approved the first tests for the detection of antibodies to HIV, the primary purpose was to screen blood donations to prevent HIV transmission from blood transfusion.6 To dissuade persons from using blood donation centers to obtain an HIV test, HIV counseling and testing programs based at “alternative testing sites” were established to provide these services. During the past 25 years, HIV testing has become more widely available and acceptable.

The Critical Role of HIV Testing in Curbing the HIV Epidemic

Testing for HIV plays a prominent role in the National HIV/AIDS Strategy released by the White House in July 2010.21 As shown in the Figure, of the estimated 1.2 million persons living with HIV in the United States, 80% are aware of their infection, 62% have been linked to HIV care, 41% stay in HIV care, 36% are receiving antiretroviral therapy, and only 28% have a suppressed viral load.19 Transmission rate modeling estimates that the 20% of persons living with HIV who are unaware of their

Barriers to Routine HIV Testing in the Health Care Setting and Potential Solutions

Health care professionals in the United States have been slow to implement the 2006 CDC recommendations for HIV screening of individuals aged 13 to 64 years. For example, only 33% of community health care personnel from Massachusetts incorporated HIV screening into their practices.33 In another study, only one-quarter of eligible patients in an emergency department were offered HIV screening,34 and less than 5% of adults seen in an emergency or urgent care setting were tested for HIV.35 These

Conclusion

The benefits of antiretroviral therapy are undisputed; it substantially reduces illness and death attributed to HIV infection. In addition, the HPTN 052 clinical trial showed that antiretroviral therapy prevents the transmission of HIV to uninfected sexual partners from HIV-infected persons receiving treatment. There is also emerging data supporting that earlier initiation of antiretroviral therapy results in improved outcomes for the individual and communities. These benefits of antiretroviral

Acknowledgments

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the CDC.

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