22 September 2006

Routine HIV tests in US?

Testing for HIV should become a routine part of medical care for Americans 13 to 64 years of age, the US Centres for Disease Control and Prevention recommended last week.

Testing for HIV should become a routine part of medical care for Americans 13 to 64 years of age, the US Centres for Disease Control and Prevention recommended last week.

It should be given much like a cholesterol or blood-pressure test, and patients should have to refuse to take the HIV test if they don't want it, CDC officials added.

The goal of the new recommendation is to increase early detection of HIV, the virus that causes Aids, and to simplify the HIV screening process in health-care settings. The recommendations also include new measures to improve diagnosis among pregnant women and further reduce mother-to-child HIV transmission.

Currently, more than 250 000 Americans are HIV-positive but don't know it, according to the CDC.

Increasing early diagnosis
"The goal is to increase the early diagnosis of HIV, so that people could access treatment, know their HIV status, and be helped and supported in efforts to take care of themselves, but also to prevent transmission to other people," CDC Director Dr Julie L. Gerberding said during a press conference Thursday.

Previous screening approaches haven't been effective in identifying many people who are HIV-positive, Gerberding noted. "These new recommendations will help us reach our ultimate goal of no child with infection, no person untreated or undiagnosed, and no transmission of HIV among people in this country," she said.

While the recommendations aren't legally binding, they are expected to influence doctors' practices and health insurance coverage.

Patients should be told that HIV testing is part of routine care and have the opportunity to decline testing. Before making this decision, however, they should be provided with information about HIV and the meaning of positive and negative test results, and should have the opportunity to ask questions, the CDC recommended.

The recommendations are only for testing in health-care settings, said Dr Kevin Fenton, director of CDC's National Centre for HIV, STD, and TB Prevention. The recommendations do not include community centres or other HIV- or health-care outreach programs.

"The goal of the new recommendations is to make sure that anyone who seeks medical care also has the opportunity to learn if they are infected with HIV," Fenton said.

Simplifying the process
The CDC is also recommending simplified testing procedures that overcome barriers to screening, such as pretest counselling and separate written consent. Both of these barriers should be removed. Rather, HIV testing should be incorporated into general consent for medical care, the agency said.

There should also be enhanced screening for pregnant women, the CDC said. The estimated number of infants born in the US with HIV declined from about 1 650 in 1991 to less than 240 this year. The new recommendations are intended to help reduce this number even further.

The recommendations also appear in the September 22 issue of the CDC's Morbidity and Mortality Weekly Report.

An important step forward
One expert thinks the new recommendations are an important step forward in HIV detection and prevention, and are a good allocation of public health-care time and dollars.

"I am very pleased to see that the CDC is now recommending routine voluntary HIV screening," said Gillian D. Sanders, an associate professor of medicine at the Duke Clinical Research Institute, at Duke University.

"Our previous research has emphasised that the case for systematic voluntary HIV testing even in low prevalence health-care settings is compelling. Routine HIV screening is able both to prolong life of the infected individuals and their potential partners, and also is a good use of our resources," she said.

And, Sanders said, the CDC's recommendation to streamline the pre- and post-counselling associated with HIV testing will considerably enhance the cost-effectiveness of routine HIV screening.

"Making voluntary HIV screening a routine part of health care will help to remove the stigma associated with testing while helping us to identify infected individuals early in their disease," Sanders said. – (HealthDayNews)

Read more:
HIV/Aids Centre

September 2006


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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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