Health Providers, Experts Back CDC HIV Testing Recommendations, Urge Caution on Implementation

Health providers and experts on Tuesday at a panel discussion said they support CDC's revised recommendations on HIV testing in the U.S. that say voluntary HIV testing should become a routine part of medical care for residents ages 13 to 64, but they emphasized caution in proceeding with the program, CQ HealthBeat reports (Hopkins, CQ HealthBeat, 10/3). The recommendations, published in the Sept. 22 edition of CDC's Morbidity and Mortality Weekly Report, say health care providers should continue routine HIV testingunless they establish that less than one of every 1,000 patients tested is HIV-positive, "at which point such screening is no longer warranted." Providers do not have to require patients to sign separate written consent forms or undergo counseling before receiving an HIV test, but physicians must allow patients to opt out of the test, according to the guidelines. The recommendations -- which states can choose to adopt and modify -- also say that all pregnant women should be tested for the virus unless they opt out and that women who inject illicit drugs, are commercial sex workers or who live in a higher prevalence region should be tested again in the third trimester of pregnancy (Kaiser Daily HIV/AIDS Report, 9/22).

Panel Details
The forum, hosted by the Kaiser Family Foundation and CDC, included Bernard Branson, associate director for laboratory diagnostics in the Division of HIV/AIDS Prevention at CDC and an author of the recommendations; David Holtgrave, a professor and chair of the Department of Health, Behavior and Society at Johns Hopkins Bloomberg School of Public Health; Marsha Martin, director of the district's Administration for HIV Policy and Programs; Frank Oldham, executive director of the National Association of People with AIDS; and Bruce Rashbaum, a physician for Capitol Medical Associates who cares for many people living with HIV/AIDS. "The penetration of responding to the epidemic has not been as deep as we all wish we could do," Martin said, adding, "People are not ready to do the testing." Rashbaum said the health care system is "ill-prepared" for "mass screening," adding that providers will not have the capacity to treat the number of new HIV cases identified. However, the estimated 250,000 HIV-positive people living in the U.S. who do not yet know their HIV status should already be in the care system. Oldham voiced his organization's support for the recommendations while noting that legal discrimination protections must be ensured and that community support systems must be in place. Holtgrave said one challenge to implementing the recommendations is a lack of overall resources, pointing out the stalled action on the reauthorization of the Ryan White CARE Act. CDC is scheduled to meet with health care providers on Oct. 16 to begin development of an implementation plan, according to CQ HealthBeat (CQ HealthBeat, 10/3).

NPR's "Talk of the Nation" on Monday included a discussion of the CDC recommendations. Guests on the program included Wendy Mariner, professor of health law at Boston University's School of Public Health; Timothy Mastro, acting director of CDC's Division of HIV/AIDS Prevention; and Greg Payne, director of the Washington, D.C. Department of Health (Martin, "Talk of the Nation," NPR, 10/2). The complete segment is available online in RealPlayer. A webcast of the discussion panel is available online.