3. Promoting HIV Testing in Diverse Populations
Development of HIV Screening Recommendations
The US Public Health Service had issued guidelines regarding HIV screening procedures in 1987, 2 years after an HIV screening test became available. In 1993, the CDC first issued guidelines regarding voluntary HIV screening and counseling in settings where HIV prevalence was high and for all pregnant women; these recommendations were revised and updated in 2001.
By 2003 the demographics of the US HIV epidemic had evolved substantially, and
the CDC introduced its initiative Advancing HIV Prevention: New Strategies for a Changing Epidemic [Advancing 2003] with two key goals:
- To make HIV testing a routine part of medical care on the same voluntary basis as other diagnostic and screening tests
- To further reduce perinatal HIV transmission by universal testing of all pregnant women and by using rapid tests during labor and delivery or postpartum for mothers not screened prenatally [Advancing 2003]
Because time constraints or discomfort with discussing patients' risk behaviors caused some providers to perceive requirements for prevention counseling and written consent as barriers [IOM 1999, Troccoli 2002, Epstein 1998, Kellock 1998], the CDC initiative advocated streamlined approaches.
In March 2004, the CDC convened an advisory meeting of healthcare providers, representatives from professional associations, and local health officials. These consultants recommended simplifying HIV screening to make it more practical and less costly and advocated more frequent diagnostic testing of patients with symptoms.
In April 2005, the CDC initiated a comprehensive review of HIV testing in healthcare settings and began to prepare recommendations to implement revised strategies. In August 2005, CDC invited healthcare providers, representatives from public health agencies and community organizations, and HIV-positive individuals to review an outline of the proposed recommendations. In November 2005, CDC convened a meeting of researchers, representatives of professional health-care provider organizations, clinicians, HIV-positive individuals, and representatives from community organizations to review the proposed recommendations.
Before final revisions, the CDC described the proposals at national meetings of researchers and healthcare providers and in March 2006 solicited peer review and invited comment from professional and community organizations. The final recommendations were further refined based on comments from these constituencies.
