January 16, 2013
The Office of the Inspector General (OIG) reported that only 20 percent of Health Resources and Services Administration (HRSA)-funded clinics adhered to CDC recommendations to provide routine HIV testing for all patients ages 13 to 64. More than half (55 percent) of the clinics followed US Preventive Services Task Force guidelines and focused HIV testing efforts on high-risk populations. Another 24 percent of HRSA-funded clinics offered HIV testing only to patients with HIV symptoms or those who requested HIV testing. One percent of the clinics tested all adult patients for HIV.
OIG based these estimates on a 2011 survey of 500 randomly selected HRSA-funded health centers. In 2011, these safety net clinics delivered primary care to more than 17 million patients in community health, migrant health, homeless health, and public housing settings. The centers attributed their failure to adhere to CDC recommendations to the lack of funding for the clinics and patients' inability to pay for HIV testing.
CDC's 2006 recommendations were designed to increase the number of people who know their HIV status and to remove stigma from HIV testing. The recommendations included: testing all patients ages 13 to 64, unless the person had already been tested for HIV or the prevalence of undiagnosed HIV was less than 0.1 percent; offering HIV testing as a standard of practice and obtaining consent for HIV testing as for other tests; and not offering prevention counseling to everyone./p>
HRSA requires clinics to report the number of persons tested for HIV, but most HRSA-funded clinics do not test enough people to establish the prevalence of undiagnosed HIV in the community. OIG stated the HRSA-funded clinics should also report the number of people diagnosed with HIV. HRSA already requires clinics funded through the Ryan White HIV/AIDS program to send this information.