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Revised Recommendations for HIV Testing

In September 2006, the US Centers for Disease Control and Prevention (CDC) published revised recommendations for
HIV screening procedures, advising that all patients 13 to 64 years of age in healthcare settings should be tested for HIV infection at least once in their lifetimes. [Branson 2006]
This marked a change in focus toward an increased stress
on greater access to HIV testing and on providing prevention
and care services for HIV-positive individuals, with a view toward reducing new infections.

These recommendations mean that healthcare providers should offer routine screening for HIV infection unless the prevalence of undiagnosed HIV infection in their patient population has been shown to be < 0.1%. In the absence of data on HIV prevalence in a particular area, individual providers and provider organizations should offer voluntary screening until data that demonstrate the presence of < 1 HIV-infected case per 1,000 patients screened, at which level routine HIV screening is no longer warranted.

Other important recommendations in this initiative include:

Informing patients that testing will be performed and that they may decline—ie, HIV testing should be an opt-out procedure
Annual testing for individuals who are considered at high risk for HIV infection
Continuation of previous recommendations regarding testing, counseling, and referral for high-risk patients
Testing as a routine part of prenatal screening, to be repeated in the third trimester

Opt-out vs Opt-in

Throughout most of the history of the HIV epidemic, opt-in testing, the usual process, has required written consent and pretest counseling, requirements that can pose barriers to performing wider testing. Routine opt-out HIV testing, on the other hand, involves performing HIV testing as part of a patient’s routine health evaluation, without pretest counseling—similar to screening for other medical conditions—while also preserving the patient’s right to decline testing.

The CDC suggested that HIV screening should be included in the forms for general consent for medical care that patients typically sign in most clinical settings—in other words, that specific written consent for HIV screening should not be required. In another important change, these 2006 guidelines recommend that, in healthcare settings, prevention counseling need not be offered with HIV diagnostic testing or as part of HIV screening.

Healthcare Settings

The 2006 recommendations are intended for all healthcare providers in both the public and the private sectors in settings where other diagnostic and screening tests are routinely performed, including:

Emergency departments
Urgent care clinics
Inpatient services (including labor and delivery)
Substance abuse treatment clinics
Public health clinics
Community clinics
Correctional healthcare facilities
Pediatric and adolescent care clinics
Prenatal care clinics
Other primary care settings

The recommendations, however, do not apply to nonmedical settings, such as mobile HIV testing vans.

USPSTF Recommendations

The US Preventive Services Task Force (USPSTF)—a program of the federal Agency for Healthcare Research and Quality—has also issued a strong recommendation that clinicians screen all adolescents and adults who may be at increased risk for HIV infection. In this context, increased risk means having ≥ 1 individual risk factor (listed below) for HIV infection or receiving healthcare services at a facility that is located in an area with a high prevalence of HIV infection or that serves a high-risk population. [USPSTF 2005]

Individual risk factors include:

Men who have had sex with other men since 1975
Men and women who engage in unprotected sexual activity with multiple partners
Past or present injection-drug use (IDU)
Men and women who exchange sex for money or drugs or have sex partners who do so
Individuals whose current or past sex partners were HIV infected, bisexual, or IDUs
Persons being treated for sexually transmitted illnesses (STIs)
Having received a blood transfusion between 1978 and 1985

Patients who request an HIV test but who do not report individual risk factors may also be considered at increased risk for HIV infection, because these are likely to include individuals who may not be willing to disclose their high-risk behaviors.

High-prevalence or high-risk clinical settings include:

STI clinics
Correctional facilities
Homeless shelters
Tuberculosis clinics
Clinics serving men who have sex with men
Adolescent health clinics that report a high prevalence of STIs
Any facility located in an area where there is known to be a ≥ 1% prevalence of HIV infection among the patient population that it serves

In addition, the USPSTF strongly recommends routine HIV testing for all pregnant women. However, the group did not recommend routine screening for adolescents and adults who are not at increased risk for HIV infection.

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	3. Promoting HIV Testing in Diverse Populations Curricula 1 2 3 4 AETC-NMC Home Curricula Home Glossary Feedback

	About Curriculum 3 Module 1: U.S. HIV Epidemiology Learning Objectives & Pretraining Assessment The HIV Epidemic in the United States The HIV Epidemic, cont. By Risk Group Key Events in the US HIV Epidemic (early 1980s - late 1990s) (2000 - present) African American Populations Hispanic/Latino Populations MSM Populations Asian and Pacific Islander Populations American Indian/Native Alaska Populations Summary References Assessment Questions Module 2: Recommendations for Routine HIV Testing Learning Objectives & Pretraining Assessment Development of HIV Screening Recommendations Rationale Underlying the 2006 Recommendations Revised Recommendations for HIV Testing Summary References Assessment Questions Module 3: Benefits of Early Testing and Risks of Delayed Testing Learning Objectives & Pretraining Assessment Timing of Initiation of HAART Guidelines on Starting Antiretroviral Therapy Benefits Associated With Early Therapy Initiation Diagnosis in the ED Risks of Delayed HIV Diagnosis and Treatment Summary References Assessment Questions Module 4: Barriers to Testing and Strategies to Improve Rates of Routine HIV Testing Learning Objectives & Pretraining Assessment Discovering Barriers to Wider Use of HIV Screening Provider-Related Barriers Impact of State and Local Laws and Regulations Population-Specific Barriers Factors That Impede HIV Testing Among Latinos Factors That Impede HIV Testing Among American Indians/Alaska Natives Factors That Impede HIV Testing Among Asian/Pacific Islanders Strategies to Improve Routine HIV Testing Working With Community Organizations Summary References Assessment Questions Module 5: HIV Testing Technologies Learning Objectives & Pretraining Assessment Point-of-Care Testing vs Laboratory-Based Testing Confirmatory Tests Availability of Results Point-of-Care Testing Issues Key Resources for Understanding and Employing HIV Testing Technologies Summary References Assessment Questions Case Studies Suggested Activities	Revised Recommendations for HIV Testing In September 2006, the US Centers for Disease Control and Prevention (CDC) published revised recommendations for HIV screening procedures, advising that all patients 13 to 64 years of age in healthcare settings should be tested for HIV infection at least once in their lifetimes. [Branson 2006] This marked a change in focus toward an increased stress on greater access to HIV testing and on providing prevention and care services for HIV-positive individuals, with a view toward reducing new infections. These recommendations mean that healthcare providers should offer routine screening for HIV infection unless the prevalence of undiagnosed HIV infection in their patient population has been shown to be < 0.1%. In the absence of data on HIV prevalence in a particular area, individual providers and provider organizations should offer voluntary screening until data that demonstrate the presence of < 1 HIV-infected case per 1,000 patients screened, at which level routine HIV screening is no longer warranted. Other important recommendations in this initiative include: Informing patients that testing will be performed and that they may decline—ie, HIV testing should be an opt-out procedure Annual testing for individuals who are considered at high risk for HIV infection Continuation of previous recommendations regarding testing, counseling, and referral for high-risk patients Testing as a routine part of prenatal screening, to be repeated in the third trimester Opt-out vs Opt-in Throughout most of the history of the HIV epidemic, opt-in testing, the usual process, has required written consent and pretest counseling, requirements that can pose barriers to performing wider testing. Routine opt-out HIV testing, on the other hand, involves performing HIV testing as part of a patient’s routine health evaluation, without pretest counseling—similar to screening for other medical conditions—while also preserving the patient’s right to decline testing. The CDC suggested that HIV screening should be included in the forms for general consent for medical care that patients typically sign in most clinical settings—in other words, that specific written consent for HIV screening should not be required. In another important change, these 2006 guidelines recommend that, in healthcare settings, prevention counseling need not be offered with HIV diagnostic testing or as part of HIV screening. Healthcare Settings The 2006 recommendations are intended for all healthcare providers in both the public and the private sectors in settings where other diagnostic and screening tests are routinely performed, including: Emergency departments Urgent care clinics Inpatient services (including labor and delivery) Substance abuse treatment clinics Public health clinics Community clinics Correctional healthcare facilities Pediatric and adolescent care clinics Prenatal care clinics Other primary care settings The recommendations, however, do not apply to nonmedical settings, such as mobile HIV testing vans. USPSTF Recommendations The US Preventive Services Task Force (USPSTF)—a program of the federal Agency for Healthcare Research and Quality—has also issued a strong recommendation that clinicians screen all adolescents and adults who may be at increased risk for HIV infection. In this context, increased risk means having ≥ 1 individual risk factor (listed below) for HIV infection or receiving healthcare services at a facility that is located in an area with a high prevalence of HIV infection or that serves a high-risk population. [USPSTF 2005] Individual risk factors include: Men who have had sex with other men since 1975 Men and women who engage in unprotected sexual activity with multiple partners Past or present injection-drug use (IDU) Men and women who exchange sex for money or drugs or have sex partners who do so Individuals whose current or past sex partners were HIV infected, bisexual, or IDUs Persons being treated for sexually transmitted illnesses (STIs) Having received a blood transfusion between 1978 and 1985 Patients who request an HIV test but who do not report individual risk factors may also be considered at increased risk for HIV infection, because these are likely to include individuals who may not be willing to disclose their high-risk behaviors. High-prevalence or high-risk clinical settings include: STI clinics Correctional facilities Homeless shelters Tuberculosis clinics Clinics serving men who have sex with men Adolescent health clinics that report a high prevalence of STIs Any facility located in an area where there is known to be a ≥ 1% prevalence of HIV infection among the patient population that it serves In addition, the USPSTF strongly recommends routine HIV testing for all pregnant women. However, the group did not recommend routine screening for adolescents and adults who are not at increased risk for HIV infection. « BACK NEXT »
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3. Promoting HIV Testing in Diverse Populations

Revised Recommendations for HIV Testing