To
coincide with the annual National HIV Testing Day on June 27, the Centers for
Disease Control and Prevention (CDC) released data from 2 studies of rapid HIV
testing in emergency care settings and at gay pride events. Both reports were
published in the June 22, 2007 issue of Morbidity and Mortality Weekly Report.
The
CDC has expanded its efforts to encourage routine HIV testing, given that about
one-quarter of the estimated 1 million people living with HIV in the U.S. are
believed to be unaware that they are HIV-infected and at risk for transmitting
the virus to others.
HIV
Testing in Emergency Departments
Results
from the first study suggest that emergency departments (EDs) should integrate
rapid HIV testing into their routine medical services. To evaluate the feasibility
and acceptability of this approach, a pilot testing program was implemented in
April 2004 at 2 EDs, one in Los Angeles and one in New York City; in January 2005,
the program was also implemented at ED in Oakland.
The
sites placed posters and brochures in their waiting and registration areas advising
patients of the availability of free rapid HIV testing. Individuals who said they
were HIV negative or did not know their HIV status were offered testing with written
consent. Preliminary testing was conducted using the OraQuik Advance Rapid HIV-1/2
Antibody Test on either oral fluid or finger-stick blood specimens; patients with
positive results received a confirmatory Western blot test.
Among
186,415 people who sought care at the 3 EDs between January 2005 and March 2006,
18.6% overall were offered rapid testing; however, this figure varied widely,
from 2.1% in New York to 3.6% in Los Angeles to 47.7% in Oakland. Overall, 56.5%
agreed to be tested, but this varied as well, from 52.8% in Oakland to 84.0% in
New York to 98.3% in Los Angeles. Among those who agreed to receive testing, more
than 99% in New York and Los Angeles, but only 38.5% in Oakland, actually did
so.
Among the
9365 people tested at the 3 EDs during the study period, 1% were newly diagnosed
with HIV infection. Of these 97 individuals, 88% received referrals to HIV care
and treatment and completed at least 1 follow-up visit.
According
to an accompanying editorial comment, "The findings in this report suggest
that offering HIV testing as an integrated part of routine health-care services
in EDs, rather than relying on a clinical- or risk-based approach to testing,
is a feasible strategy for identifying persons with previously undiagnosed HIV
infection who might not otherwise access HIV-testing services."
The
authors added that if a risk-based approach had been used, nearly half of the
newly diagnosed individuals in this study (48%) would not have been offered testing.
Testing
at Gay Pride Events
The
second study assessed the feasibility of rapid HIV testing of racial and ethnic
minority men who have sex with men (MSM) at gay pride events. Between 2004 and
2006, rapid testing was offered at black gay pride events in Baltimore; Charlotte;
Detroit; Jackson, MS; St. Louis; and Washington, DC, Latino gay pride events in
Oakland and San Francisco, and general gay pride events in Chicago and Oakland.
Among
543 attendees who reported that they had not previously tested HIV positive, 24%
were given rapid tests during the events; 6% of these individuals had positive
results, all of which were confirmed with Western blot tests. Among the 8 men
with newly diagnosed HIV, 4 reported negative tests during the preceding year,
1 had never been tested, and 3 had an unknown testing history.
"Testing
at gay pride events provides an opportunity to identify new HIV infections among
MSM outside of health-care settings, particularly those from racial/ethnic minority
groups," the authors concluded.
Advocates
Release HIV Testing Guidelines
Numerous
health, advocacy, and public service organizations held events or launched initiatives
on National HIV Testing Day to encourage more people to learn their HIV status.
Several of these featured celebrities and targeted underserved populations, especially
blacks and Latinos.
Amid
this flurry of testing encouragement, however, others sounded a note of caution.
On June 26, Lambda Legal, the AIDS Foundation of Chicago, and the Center for HIV
Law and Policy released a broadly endorsed set of fundamental principles to guide
HIV testing policies and programs.
The
group of legal and medical professionals and service providers emphasized that
as efforts continue to expand HIV testing programs, testing must remain "informed,
voluntary, confidential, and supported by health care."
"Expanded
testing can be valuable, but it must be well planned, high quality, and client
centered," said David Ernesto Munar of the AIDS Foundation of Chicago.
"We
cannot lose sight of the people who will be tested," added Bebe Anderson,
Lambda Legal's HIV Project Director. "Respect for the civil and human rights
of patients must be at the heart of successful efforts to increase testing."
EE
Telzak, F Grumm, J Coffey, and others. Rapid HIV Testing in Emergency Departments
-- Three U.S. Sites, January 2005-March 2006. Morbidity and Mortality Weekly
Report 56(24): 597-601. June 22, 2007.
T
Dowling, O Macias, D Sebesta, and others. Rapid HIV Testing Among Racial/Ethnic
Minority Men at Gay Pride Events -- Nine U.S. Cities, 2004-2006. Morbidity
and Mortality Weekly Report 56(24): 602-604. June 22, 2007.
Kaiser
Family Foundation. HIV/AIDS Initiatives Targeting At-Risk Groups To Launch on
National HIV Testing Day. Daily HIV/AIDS Report. June 27, 2007.
Lambda
Legal. HIV Legal, Medical and Service Providers Launch Guide to HIV Testing. Press
release. June 26, 2007.
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