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August 2011 Clinical Laboratory News: CDC HIV Screening Initiative Tests 2.8 Million

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August 2011: Volume 37, Number 8

CDC HIV Screening Initiative Tests 2.8 Million

A 3-year, $111 million Centers for Disease Control and Prevention (CDC) program to expand access to HIV testing in areas most affected by HIV has diagnosed more than 18,000 individuals who were previously unaware of their HIV infection (MMWR 2011:60:805–810). The agency reported in June that the Expanded HIV Testing Initiative (ETI) produced nearly 3 million screening tests, of which 1.1% were positive and 0.7% resulted in new HIV diagnoses. In addition, of the newly diagnosed individuals for whom follow-up data was available, three-quarters were successfully linked to follow-up care.

The first nation-wide effort to promote routine HIV screening, this ambitious testing program started in 2007 with special funding to 25 health departments, a year after CDC issued new recommendations calling for non-targeted HIV screening for all persons age 13–64. ETI focused on populations disproportionally affected by HIV, especially non-Hispanic blacks. Clinical settings accounted for 90% of all tests and 81% of new diagnoses.

“This three-year effort clearly shows that routine HIV testing is a powerful way to reach those who don’t know their status and link them to life-saving care and information,” said Jonathan Mermin, MD, director of CDC’s Division of HIV/AIDS Prevention. “It also highlights the importance of collaboration between health departments and clinical-care providers to provide routine HIV screening, especially in populations disproportionately affected by HIV. With nearly a quarter of a million Americans unaware of their HIV infection, it’s urgent that we make HIV testing easily available, especially among those who need it most.”

A key part of the program was improving linkage to care, Mermin emphasized. To that end, ETI grantees employed several different strategies. Linkage to care was particularly successful when the site conducting the testing was part of a larger healthcare system that included providers or clinics specializing in HIV treatment, so patients could immediately connect with HIV care staff in person. Even when this was not the case, health departments also provided a crucial safety net. Disease intervention specialists double-checked that patients had the necessary care appointments and followed-up if they missed a visit.

In another approach called preemptory linkage to care, providers connected patients who had a preliminary positive result to care even before they received confirmatory test results. This was done to minimize attrition.

ETI will continue, and CDC now provides funding to 30 areas to reach several populations heavily affected by HIV, including African-Americans, gay and bisexual men, Latinos, and injection drug users.

The CDC report available from the CDC website.