Cost, State Laws, Reluctance of Some Family Physicians Expected To Delay Implementation of CDC Recommendations for Routine HIV Testing

Complex state HIV testing laws, reluctance of some family physicians to administer tests to their patients and testing costs are expected to delay for at least one year the implementation of CDC's recommendations for routine HIV testing in many parts of the country, some public health officials said recently, the AP/Macon Telegraph reports (AP/Macon Telegraph, 10/6). The recommendations, published in the Sept. 22 edition of CDC's Morbidity and Mortality Weekly Report, say that voluntary HIV testing should become a routine part of medical care for residents ages 13 to 64. In addition, they say that health care providers should continue routine HIV testing unless they establish that fewer 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 are injection drug users, 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, 10/4). According to the AP/Telegraph, laws in at least 24 states require pretest counseling, and some states have other regulations that might obstruct physicians from implementing CDC's recommendations. Some health experts say cost also could be an issue in adhering to the guidelines. HIV tests range from $3 to $15 or more, and while some medical facilities have been offering rapid tests at no cost through private and public funding, such resources "will end someday and then paying for the test will become an issue," the AP/Telegraph reports. Health insurers said they are considering covering new routine testing. The 94,000-member American Academy of Family Physicians declined to take a position on CDC's recommendations, questioning the potential cost and necessity of the guidelines. In addition, some health care providers who currently refer patients who test HIV-positive to a specialist for counseling and treatment might be unprepared to give patients the initial diagnosis under the new guidelines, Kimberly Manning, an internist at Grady Memorial Hospital in Atlanta, said. According to the AP/Telegraph, CDC, the American Medical Association and other groups are scheduled to convene Oct. 16 in Atlanta to address many of these issues (AP/Macon Telegraph, 10/6).