Routine HIV Testing Hits the Primary Care Clinic

Abstract

In September 2006, the Centers for Disease Control and Prevention (CDC) recommended screening all persons 13–64 years of age for human immunodeficiency virus (HIV) infection.1 Prior to this, screening recommendations were targeted to specific high-risk individuals and settings, and to all pregnant women. The rationale for expanded screening is that early diagnosis can reduce morbidity and mortality,2 and that persons who know their HIV status will modify their risk behaviors and reduce transmission.3 Furthermore, an estimated 25% of persons with HIV infection remained undetected with the existing screening strategy. Recently, the American College of Physicians and the HIV Medicine Association have come out in support of the CDC’s screening recommendation.4 Other organizations, such as the US Preventive Services Task Force, have not come out for or against the CDC recommendations, in part due to limited direct evidence on the benefits of screening.5 As new evidence emerges, key issues to consider for any screening program are the validity of the screening test, the feasibility of implementing the screening program, and the overall effectiveness in improving health outcomes. In this issue of JGIM, Myers and colleagues describe their experience of systematically implementing the CDC recommendations within six community care centers in the Southeastern US6. With programmatic support and some funding, the practices developed a systematic procedure to implement screening within the practice that did not directly involve the health care provider. In this study, over 16,000 persons were offered HIV testing, and of the 10,769 persons who accepted testing, 19 received a false-positive result, whereas 17 were confirmed positive, of whom 12 were successfully referred to care. Three patients did not have confirmatory testing. The findings from this study demonstrate key issues involving screening test validity and feasibility.