CDC Study Finds Benefit to Routine HIV Testing at Urgent Care Clinics in ‘High HIV Prevalence’ Areas
Offering voluntary HIV testing to all patients admitted to urgent care clinics in areas with "high HIV prevalence" could help detect infection earlier and lead to the identification of previously undiagnosed HIV-positive individuals, the CDC reports in the June 29 issue of the Morbidity and Mortality Weekly Report. The CDC in 1993 recommended that hospitals and "associated clinics" in areas of high HIV prevalence offer voluntary HIV testing to all patients ages 15 to 54. In 1997, a study at the Grady Memorial Hospital in Atlanta, Ga., found that nearly two-thirds of inpatients newly diagnosed with AIDS had received medical care within the Grady health system during the 12 months preceding their admission. Stating that the previous admissions represented "missed opportunities for earlier diagnosis of HIV," the CDC launched a study that examined the effectiveness of different policies regarding HIV screening in areas of high HIV prevalence. Over a 24-week period in 1999, staff at the Grady hospital recommended HIV screening to patients at the urgent care clinic "only when [they] were concerned about patients' symptoms or risk behaviors." Over an identical time period the following year, staff "were encouraged to recommend HIV testing to all urgent care clinic patients ages 18 to 65 years who were neither known" to be HIV-positive nor tested within the preceding six months, regardless of risk factors. The agency found that in 2000, HIV testing was administered to 1,687 more patients than in 1999. Twenty-seven more infections were newly reported in 2000 as compared to 1999; 27 more patients were informed of their HIV-positive test result; and twice as many HIV-positive patients entered into care. The scientists added that because hospitals recommended screening to all patients, those who were HIV-positive "may have had HIV detected at an earlier stage of infection."
Routine Screening Recommended
An accompanying CDC editorial says that the findings of the study indicate that "when providers at an urgent care clinic in a high prevalence area routinely recommended HIV testing, more persons were tested, more HIV infections were detected and more patients with newly detected infections learned their diagnosis and entered into care." The agency notes that "time demands" and cost could prove to be barriers to such hospitals offering HIV screening, but adds that posters and brochures could help save time by informing patients of "basic" HIV testing information. The CDC also notes that public health departments and other HIV prevention programs could help cover the cost of implementing routine screening. The editorial concludes, "Recommending HIV testing routinely in clinical settings presents an opportunity to target high prevalence communities, destigmatize HIV testing and better link [HIV-positive] persons to care and prevention services" (Del Rio et al., "Routinely Recommended HIV Testing at an Urban Urgent Care Clinic -- Atlanta, Georgia, 2000," Morbidity and Mortality Weekly Report, 6/29).