HIV Testing in Health Care Settings

The Case for Increased HIV Testing

The Center for Disease Control and Prevention’s (CDC) objectives for incorporating routine HIV screening into health care are:
  * to increase HIV screening of patients, including pregnant women, in all health care settings;
  * to foster earlier detection of HIV infection;
  * to identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services;
  * and to further reduce perinatal transmission of HIV in the United States (CDC,2006).

Rationale for Routine HIV Screening
The effectiveness of using risk-based testing to identify HIV infected persons has diminished due to increases in infection among:
  * individuals ages <20
  * individuals residing in non-metropolitan areas
  * minorities
  * heterosexual individuals who are unaware they are infected

Therefore, no specific population is targeted for HIV testing (CDC,2006).

Criteria that Justify Routine Screening
Screening is a proven public health tool that has been effective for the prevention and control of numerous diseases. HIV meets the generally accepted criteria that justify routine screening:
  *It is a serious health disorder that can be detected while it is still asymptomatic.
  *Treatment is more effective when it is begun before symptoms develop.
  *There is reliable, inexpensive, acceptable, and accurate screening tests available.
  *The cost of screening is reasonable in relation to the anticipated benefits.*

CDC Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings
The following information is a summary of the revised recommendations for HIV testing of adults and adolescents and is intended for all healthcare settings. HIV/STD testing in pregnancy is addressed in detail in the Provider/Perinatal Provider section and is based on Florida law.
  *Routine, voluntary HIV screening, not based on risk, for all persons 13 – 64 years old in all health care settings.
  *Repeat HIV screening of persons with known risk at least annually.
  *Opt-out HIV screening with the opportunity to ask questions and the option to decline.
  *Include HIV consent with general consent for care; separate signed informed consent is not recommended.
  *Prevention counseling in conjunction with HIV screening in health care settings is not required.

Some states have specific laws with regard to written informed consent or pretest counseling.

Informed consent is required:
  * Every attempt should be made to get a signed consent.
  * Oral consent must be documented in the medical record.

Patients must be notified:
  * Anonymous (no name used) testing is available.
  * HIV is a reportable disease.
  * Results are confidential.

Pre-test counseling must be offered:
  * This can be in the form of flyers, posters, brochures, videos, handouts or discussion.
  * Information should be easy to understand and in the appropriate language.
  * Family or friends should not be used as translators.

Must cover:
  * Explanation of the testing process
  * What a negative result means
  * What a reactive result means
  * Confirmatory testing
  * Prevention and protection

Post-test counseling:
  * The results of a reactive test means you are most likely infected.
  * A confirmatory test will be done and the results will be sent to the local health department.
  * Review the importance of prevention and protection
  * If the confirmatory test is positive you will be contacted by a Disease Intervention Specialist   from the health department.
  * The local health department will provide links to services in the community
  * If the confirmatory test is negative, re-test in 3 months.

*Principles and Practice of Screening for Disease; WHO Public Health Paper, 1968; Branson nd

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