California: Routine HIV Testing Poses New Problems for Health Officials

In September, CDC recommended universal, voluntary HIV tests for all patients ages 13-64 in clinical settings as a way to link more of those HIV-infected but unaware to treatment and care. Many California providers, however, have questions about the logistics and costs of implementing the recommendations.

The Palo Alto Medical Foundation has clinics in Fremont, Los Altos, Palo Alto, Potola Valley and Redwood Shores. Its physicians are still investigating how -- or whether -- to implement CDC's HIV testing recommendation, said the foundation's Dr. Charles Weiss. "We all felt sympathetic to the CDC's position -- there are 40,000 new HIV infections a year -- but we had some concerns about it," he said. There is no strong evidence screening low-risk patients improves their health, he said. And positive results would need to be handled systematically. "We're used to targeted screening and written informed consent. We like to do things carefully and well," Weiss said.

CDC's recommendations target the estimated 250,000 Americans who are infected but do not know it. Nearly 40 percent of HIV diagnoses are made within a year of progression to AIDS, and persons who are unaware they are infected are 3.5 times more likely to infect others than HIV-positive people who know their status. In October, the California Medical Association endorsed the testing recommendations and encouraged members to implement them.

"One of my frustrations with the CDC recommendations is they are based on public health services, not on a private system," said Michael Allerton, HIV operations and policy leader of Kaiser Permanente California, which insures 3.2 million people in the region. Based on CDC estimates, 1,800 Kaiser patients may be infected but unaware, Allerton said. Testing everyone recommended may not be cost-effective even if it leads to earlier treatment for those infected, he said.

At Oakland's Highland Hospital, every emergency-room patient has been offered rapid HIV testing since January 2005, under a CDC grant. Eight percent (6,410) of the patients were tested; of these, 83 were HIV-positive. Seventy-three percent of these were then linked to care, though this "didn't happen without a lot of pursuing of patients," said Highland's Steve Kilgore, manager for HIV services.

Back to other news for December 5, 2006