Targeting HIV Testing at High-Risk Groups Might Be More Effective Than Routine Testing, Research Article Says
June 13, 2007
Targeting HIV testing at high-risk groups and populations might be a more effective method of identifying people who are unaware of their HIV-positive status than conducting routine testing among all U.S. residents ages 13 to 64, David Holtgrave, a epidemiologist with the Johns Hopkins Bloomberg School of Public Health, writes in research article in the June 12 issue of PLoS Medicine, the Baltimore Sun reports (Bor, Baltimore Sun, 6/12). CDC in September 2006 released revised recommendations on HIV testing in the U.S. The recommendations advise that HIV tests become a routine part of medical care for residents ages 13 to 64 and that requirements for written consent and pretest counseling be dropped (Kaiser Daily HIV/AIDS Report, 3/15).
According to Holtgrave, who headed CDC's Division of HIV/AIDS Prevention in the late 1990s, the U.S. health care system would spend about $864 million in one year to diagnose nearly 57,000 new HIV cases using the routine testing system. The data is based on the assumption that 1% of people tested are HIV-positive. However, the health care system could identify up to 188,170 new HIV cases for the same cost by targeting drug-treatment facilities, prisons and community health centers in high-risk neighborhoods, he says. He notes that these target groups have a higher risk of contracting HIV than the general population and less access to routine health care. Targeted testing also would focus on people known to have drug habits or engage in high-risk sexual activities, regardless of where they live, according to the Sun.
CDC recognized that universal HIV testing "could encroach heavily" on doctors' workloads, so the agency dropped the requirements for written consent and pretest counseling, the Sun reports. However, Holtgrave says that pretest counseling is an essential way to educate patients about HIV prevention. He also estimates that targeted testing and counseling would prevent more than 14,000 new HIV cases annually at a cost of $59,000 per case prevented, compared with 3,600 cases at a cost of $237,000 each using CDC's guidelines.
"I don't want to make it seem that I'm anti-testing -- the question is whether there are better ways to do this," Holtgrave said. Under CDC recommendations, there would be "a lot of testing and not much in the way of diagnosis," Holtgrave said, adding that "if we don't do the counseling of people at risk, we're not going to do much in the way of prevention." According to Timothy Mastro, deputy director of the CDC's Division of HIV/AIDS Prevention, the federal government has focused on reaching high-risk populations. CDC's new recommendations seek to broaden testing by reducing "missed opportunities" in physicians' offices, emergency departments and elsewhere, he said. "There's a role for targeted testing of people perceived to be at risk," Mastro said, adding, "It's brought us a long way on HIV prevention but not far enough" (Baltimore Sun, 6/12).
The research article is available online.
A kaisernetwork.org interview with Holtgrave is available online.
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This article was provided by Henry J. Kaiser Family Foundation. It is a part of the publication Kaiser Daily HIV/AIDS Report. Visit the Kaiser Family Foundation's website to find out more about their activities, publications and services.