CDC says more routine HIV screening would reduce new infections
Clinicians aren't offering HIV testing to many people unaware they are infected with the virus. More routine testing and digital tools to help remind clinicians would go a long way toward treating infected patients and ending stigmas and barriers to care, according to public health experts.
"Clinicians who have a routine way to assess sexual risk are more likely to offer HIV testing," said Cyprian Wejnert, an epidemiologist with the Centers for Disease Control and Prevention's Division of HIV/AIDS Prevention. "However, we need to make the process easier."
Wejnert was lead author of a report published Tuesday in JAMA that found approximately half of individuals at higher risk for contracting HIV—such as men who have sex with men and people who inject drugs—were not tested for the virus in the past year and said they were not offered testing by clinicians during routine visits.
An estimated 15% of people living with HIV did not know they were infected, according to the study, but they accounted for about 40% of new HIV transmissions in the U.S. every year. The overall number of new HIV infections in the U.S. has fallen for the past several years, from 41,800 in 2010 to 38,500 in 2015, according to the CDC.
But the opioid epidemic has brought about new cases. Injection drug use accounted for 40% of all new HIV infections in 1990, but fell to make up just 6% of cases by 2015. In 2015, however, cases began to slightly increase for the first time in two decades, going from 2,392 cases in 2014 to 2,635 in 2015. A large contributor to the increase was the HIV outbreak that occurred from late 2014 to early 2015 in Scott County, Ind., where most of the 181 people who contracted HIV did so through sharing infected needles.
Separately, young gay and bisexual men accounted for 81% of all new HIV diagnoses in people aged 13 to 24 in 2016, with young black gay and bisexual men among the most severely affected groups.
Since 2006, the CDC has suggested clinicians routinely screen all people age 13 to 64 and to test those at higher risk every year. But a recent CDC study found only little more than a third of U.S. adults tested for HIV between 2006 and 2016. Those who had been tested waited three years between tests. Among higher-risk individuals, only 62% were ever tested for HIV, with the median interval since their last test being 512 days, or nearly a year-and-a-half.
Clinicians say patients worry positive diagnoses might lead them to be ostracized by their family and friends.
Dr. Margaret Hoffman-Terry, an HIV specialist at Lehigh Valley Hospital in Allentown, Pa., and board chair at the American Academy of HIV Medicine, said the CDC guidelines call for adults to be tested at least once, only to get tested again based on their amount of risk.
"Time and time again studies show that providers are very bad at predicting risk," Hoffman-Terry said. "And patients often don't disclose." She said the recommendations should reflect the importance of making HIV testing a more regular clinical practice and that alerts prompting clinicians to test for HIV should be part of a hospital's electronic health record system, the same way hepatitis C is currently handled.
"The most effective strategies toward increasing testing are those that do not place additional demands on clinicians or patients and can be seamlessly integrated within the normal clinical workflow," Wejnert said.
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