Public Health/Opt-out HIV Testing as a Public Health Tool

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Public Health/Opt-out HIV Testing as a Public Health Tool

March 2008

Medscape Special Report, Opt-out HIV Testing as a Public

Health Tool, a free, CME-certified newsletter that focuses on the

recommendations of the Centers for Disease Control and Prevention (CDC) in

regard to expanded HIV testing.

This edition of our Special Reports on this topic is written specifically with

public health professionals in mind and brings you the expertise of the leaders

in this field: Dr. Bernard M. Branson, the CDC's point person on HIV testing;

and Drs. Wayne A. Duffus and Wilbert Jordan, who have vast experience in their

own public health department and clinic.

This newsletter comprises a single CME activity with easy-to-navigate

links to an original Clinical Update, an Expert Interview with a leader in the

field, and a Test and Teach Case, all of which must be read before being

eligible to take the post-test.

INTRODUCTION

In the fall of 2006 the CDC published recommendations for a major change in the

approach to testing for HIV infection in the United States: expanded screening

in all healthcare settings for all persons age 13-64, with streamlined

procedures for consent and pretest information.

The specific recommendations included expanded HIV screening for patients

regardless of risk; revisions to procedures for separate, written informed

consent; and decreased emphasis on prevention counseling. More than 1 million

Americans are estimated to be living with HIV, nearly a quarter of whom are not

aware of their condition, and at least 40,000 new infections occur each year.

The recommendations of the CDC represent a significant revision to prior

editions and shift the paradigm of risk-based HIV testing that had prevailed,

but failed in many respects, in decades past. This quantum change occurred

through the recognition of several changes to the HIV landscape:

Effective antiretroviral therapy transformed HIV from a fatal disease to a

highly treatable chronic condition, altering the risk-benefit ratio of HIV

testing.

Knowing one's HIV-infected status sharply curtails further HIV

transmission; this should lead to considerable reduction in new

infections. Advances in testing methodology (including rapid, and oral, HIV

tests) make testing feasible in expanded venues and increase the likelihood of

linkage to effective care.

Previous efforts that focused on changing behavior in the large,

uninfected population to prevent HIV acquisition have been insufficient to stem

the spread of HIV.

The 2006 CDC recommendations provide an opportunity to accelerate

domestic HIV prevention efforts through increasing the proportion of

individuals who know their HIV status and promoting earlier access to

effective treatment. We hope that this Medscape Special Report will lead to a

wider recognition of the importance of this initiative and a

resultant increase of HIV recognition, testing, diagnosis, and care.

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