AETC-NMC | Curricula

Summary

Over the years of the epidemic, clinical guidelines—including the most frequently cited ones, from the US Department of Health and Human Services and the International AIDS Society–USA—have increasingly recommended initiation of antiretroviral therapy at earlier stages in HIV disease progression. This is where the recommendation for making HIV testing a part of routine medical care is particularly relevant—HIV-positive individuals whose condition is identified earlier can be linked to care, thereby improving their own health, reducing the risk of further HIV transmission, and reducing their communities’ overall viral load.

A range of clinical trials have clearly demonstrated the clinical and virologic benefits of beginning treatment in patients with CD4+ cell count ≤ 350 cells/mm3, and growing amounts of evidence from other studies is adding support to the practice of initiating therapy in patients with even higher CD4+ cell counts who are at earlier stages of HIV disease progression. Additional reasons to begin treatment earlier include:

HIV-positive persons who are not receiving HAART may be at increased risk for many non-AIDS–defining conditions, including cardiovascular disease, kidney disease, liver disease, and several types of malignancy.
Individuals with undiagnosed and untreated HIV infection are at risk of developing resistance to antiretroviral drugs.
Providing effective treatment and encouraging behavior change are associated with lower incidences of HIV transmission in individuals who are aware that they are HIV-positive vs those who are not aware that they are positive.

On the other hand, there are also serious individual and community risks when cases of HIV infection remain undetected and untreated, including:

Decreased immune function, along with high morbidity and hospitalization rates
Emergence of drug-resistant viral populations
Increased costs associated with later treatment
Risk of continuing HIV transmission

Taken together, all of these factors stress the serious individual, community, and financial issues that can be associated with delayed identification and treatment of HIV-positive individuals and emphasize the significant benefits that can be realized with routine HIV screening programs.

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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	Summary Over the years of the epidemic, clinical guidelines—including the most frequently cited ones, from the US Department of Health and Human Services and the International AIDS Society–USA—have increasingly recommended initiation of antiretroviral therapy at earlier stages in HIV disease progression. This is where the recommendation for making HIV testing a part of routine medical care is particularly relevant—HIV-positive individuals whose condition is identified earlier can be linked to care, thereby improving their own health, reducing the risk of further HIV transmission, and reducing their communities’ overall viral load. A range of clinical trials have clearly demonstrated the clinical and virologic benefits of beginning treatment in patients with CD4+ cell count ≤ 350 cells/mm3, and growing amounts of evidence from other studies is adding support to the practice of initiating therapy in patients with even higher CD4+ cell counts who are at earlier stages of HIV disease progression. Additional reasons to begin treatment earlier include: HIV-positive persons who are not receiving HAART may be at increased risk for many non-AIDS–defining conditions, including cardiovascular disease, kidney disease, liver disease, and several types of malignancy. Individuals with undiagnosed and untreated HIV infection are at risk of developing resistance to antiretroviral drugs. Providing effective treatment and encouraging behavior change are associated with lower incidences of HIV transmission in individuals who are aware that they are HIV-positive vs those who are not aware that they are positive. On the other hand, there are also serious individual and community risks when cases of HIV infection remain undetected and untreated, including: Decreased immune function, along with high morbidity and hospitalization rates Emergence of drug-resistant viral populations Increased costs associated with later treatment Risk of continuing HIV transmission Taken together, all of these factors stress the serious individual, community, and financial issues that can be associated with delayed identification and treatment of HIV-positive individuals and emphasize the significant benefits that can be realized with routine HIV screening programs. « BACK NEXT »
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3. Promoting HIV Testing in Diverse Populations

Summary