Despite CDC guidelines advising routine HIV counseling, testing, and referral in hospitals where HIV prevalence exceeds 1 percent, an estimated 180,000-280,000 people in the United States have undiagnosed HIV. In 2003, CDC began promoting "New Strategies for a Changing Epidemic" to make "HIV testing a routine part of medical care." The authors designed "Think HIV" to provide routine, voluntary HIV counseling, testing, and referral at 4 Massachusetts hospital-associated urgent care centers in high HIV prevalence areas.

From January to September 2002, Think HIV offered routine HIV counseling, testing, and referral to 7,026 patients, 2,620 of whom accepted, and 2,444 of whom had completed HIV test results at the time of the report. During the same time, state-funded counseling, testing, and referral sites within 10 miles of Think HIV sites (self-referral sites) completed 13,890 tests. The researchers compared Think HIV's positive diagnostic yield with that of the self-referral sites with chi-square tests. Think HIV identified 48 new HIV diagnoses (2 percent undiagnosed HIV prevalence) compared to 262 new diagnoses at self-referral sites (1.9 percent undiagnosed HIV prevalence).

The authors also compared patient demographics using chi-square tests. "Gender, race/ethnicity, previous HIV testing, and risk behaviors of Think HIV patients differed significantly from those of self-referral patients but HIV prevalence stratified by these characteristics did not," the researchers wrote. "The distribution of patients who were HIV infected differed by risk of transmission between the 2 types of counseling, testing, and referral programs (P<.0001)."

Among infected Think HIV patients, 12.2 percent were men who had sex with men. None were injection drug users.

A total of 1,382 of the 2,444 patients (56.5 percent) tested by Think HIV returned for results, 56 percent among HIV-negative patients and 88 percent among patients with HIV. Of the 48 HIV-positive patients, 42 were told their results. All had documented linkage to care, defined as at least 1 outpatient HIV primary-care visit.

The authors found that Think HIV reached a higher proportion of African Americans and risk behavior categories (except MSM) than self-referral screening. It also yielded a higher prevalence of HIV-positive MSM than self-referrals. Think HIV costs were less than $5,000 per each newly identified HIV-positive patient and $5,500 for each patient linked to care.

"Programs such as Think HIV will be most efficient in areas of highest HIV prevalence," the researchers concluded. "An extension of routine HIV counseling, testing and referral programs similar to Think HIV in high HIV prevalence settings may have substantially higher positive diagnosis yields than our already successful program."

Back to other news for February 2, 2005

Search the Newsroom archive