Christina Price, MPH
Delta Region AIDS Education and Training Center
CDC Recommendations for
HIV Testing of
Adults and Adolescents
I’m so glad we are going to talk about the CDC’s
Testing Recommendations.
Now I don’t have to worry or think about
State Testing Laws!
True or False?
Disclaimer
• CDC recommendations are NOT law
• Adults
• Adolescents
• Pregnant Women
• Health Care Settings
Recommendations for Adults and
Adolescents
1) All persons 13-64 years of age
•
ROUTINELY & VOLUNTARILY
2) All patients initiating treatment for TB
3) All patients seeking treatment for STDs
4) Repeat screening annually for those known to be at high risk
5) Encourage testing before initiating a new sexual relationship
Rationale
• Numbers are going up among:
• Treatment is effective
• Persons with known status 3.5X less likely to infect
• Technical advances in testing methods
• Efforts focused on behavior change have been insufficient
• Insufficiency of earlier testing practices
Rationale
• Patients are more likely to accept HIV testing
• Routine testing reduces stigma
• Prevention strategies incorporating universal HIV
screening have been highly effective
6 ) Opt-out Testing
• Patient notified an HIV test will be performed
• Patient may elect to decline or defer testing
• Consent is inferred unless test is declined
• Patients notified an HIV test is a routine part of care
• No requirement for separate written informed consent
• Patients must specifically decline testing (orally or in
writing) to be exempt from having an HIV test
• “Unless you object, we will test your blood for HIV.”
Consent and Pretest Information
• Informed orally or in writing
• Explanation of HIV infection
• Meanings of positive and negative results
• Opportunity for questions
• Must be voluntary
• Incorporated into patient’s general
consent for medical care
7) Diagnostic Testing
• Signs or symptoms consistent with:
• HIV infection
• Opportunistic illness
• Watch for acute infection
• Use an RNA test with an antibody test
• Notify patient of:
•
•
•
•
Plan to test
Indication for test
Implications of positive and negative test results
Offer opportunity to ask questions and decline testing
I have experience using or know how to use an
HIV Rapid Test.
True or False?
Advances in HIV Testing Technology
• Six rapid tests now available
• 4 CLIA waived
• Require saliva or a drop of blood
• No specialized equipment
• Yield results in 10-20 minutes
• Sensitivity of 99.6-100% & specificity of 99.7-100%
8) Prevention Counseling
• Do not require as a part of HIV screening programs
• Strongly encouraged for persons in high risk settings
• Time Constraints
Evidence for Adoption of the Revised Recommendations
Results from HIV Screening Programs in Healthcare Settings
Setting
Total
Tested
Total
Positive
% Positive
Emergency
Departments
64,217
629
0.98%
Primary Care
7,233
22
0.3%
Mixed Venues
58,190
926
1.59%
Hospital/Ambulatory
103,233
963
0.93%
HIV/STD Clinics
5,634
85
1.51%
Prisons
10,279
219
2.13%
588
23
3.91%
249,374
2,867
1.15%
Mental Health Clinics
Total
Recommendations for Pregnant Women
If my pregnant patient/client declines an HIV
test I can insist that she take one on behalf of
the unborn child.
True or False?
9) Universal Opt-Out Screening
ALL pregnant women should be screened for HIV
during each pregnancy
- Voluntary and with the patient’s knowledge
- Note in chart if test is declined
• Address reasons for declining a test
Rationale
• Allows for benefit of appropriate and timely:
• Treatment interventions
• Scheduled cesarean delivery
• Avoidance of breastfeeding
• Screening more effective than risk-based testing for:
• Detecting unsuspected maternal HIV infection
• Preventing perinatal transmission
Universal Opt-Out Screening
• Test as early as possible during the pregnancy
• A second test is recommended if:
• HIV incidence is high
• Known high risk for HIV infection
• Signs or symptoms consistent with acute HIV infection
Postpartum/Newborn Testing
• If status is unknown at the time of delivery, screen
immediately
• If status is unknown postpartum, screen newborn
• Inform mother a reactive test indicates she is infected
• Benefits of neonatal ART prophylaxis best if initiated
< 12 hours after birth
• If an infant is in foster care and status is unknown,
inform person authorized to provide consent
10) Communicating Test Results
• Communicate confidentially and in person
• Do not use family members as interpreters
• Follow with linkages to care and support services
• May communicate without personal contact
• Advise periodic testing for high risk patients
• Offer high risk patients prevention counseling
HIV Testing Recommendations
• Recommendations can be found on the CDC’s
website
• Questions??