HIV testing identifies HIV-positive persons, allowing for reduced future HIV transmission while simultaneously providing policy makers with surveillance data to inform policy planning. If current costs of HIV testing were reduced, these funds could be redirected to increase testing rates or to expand treatment. The cost of testing is lowered and impact increased if noninvasive (oral and urine), rapid-testing modalities are utilized, pretest counseling uses cost-efficient counseling methods (e.g., video, pamphlets, small group discussions), and opt-out consent strategies are implemented while posttest counseling is more narrowly targeted to HIV-positive persons. Rather than relying on one international standard, customizing HIV testing procedures to local environments may be more efficient and effective. In the United States, laboratories with substantial HIV testing revenues are likely to be most resistant to altering current practices. However, AIDS researchers, policy makers, and advocates may dramatically influence the epidemic's course by encouraging flexibility and innovation in HIV-testing guidelines.
"The new CDC guidelines released in September 2006 recommend dropping separate informed consent for HIV testing.15 In related research, we have found that the time required for informed consent and counseling are significant barriers to testing,27 as have others.28 We also note, however, that the quality-of-care literature finds that failure to perform indicated tests and interventions is common across many diseases in many health-care delivery systems,29 so other factors may be important. "
[Show abstract][Hide abstract] ABSTRACT: Early identification of HIV infection is critical for patients to receive life-prolonging treatment and risk-reduction counseling. Understanding HIV screening practices and barriers to HIV testing is an important prelude to designing successful HIV screening programs. Our objective was to evaluate current practice patterns for identification of HIV.
We used a retrospective cohort analysis of 13,991 at-risk patients seen at 4 large Department of Veterans Affairs (VA) health-care systems. We also reviewed 1,100 medical records of tested patients. We assessed HIV testing rates among at-risk patients, the rationale for HIV testing, and predictors of HIV testing and of HIV infection.
Of the 13,991 patients at risk for HIV, only 36% had been HIV-tested. The prevalence of HIV ranged from 1% to 20% among tested patients at the 4 sites. Approximately 90% of patients who were tested had a documented reason for testing.
One-half to two-thirds of patients at risk for HIV had not been tested within our selected VA sites. Among tested patients, the rationale for HIV testing was well documented. Further testing of at-risk patients could clearly benefit patients who have unidentified HIV infection by providing earlier access to life-prolonging therapy.
Journal of General Internal Medicine 04/2007; 22(3):315-20. DOI:10.1007/s11606-006-0028-9 · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to examine time trends of failure to return for HIV test results among a mobile van population in Los Angeles.
This study examined administrative records from 9340 patients of the Mobile HIV Testing van between January 1997 and December 2004.
Between 1997 and 2004, a worsening trend was found in the percentage of clients who failed to return for HIV test results. Multivariate analyses showed that the adjusted odds of returning for test results significantly increased relative to 1997, the first year tested. The odds of returning for test results ranged from 1.56 (95% CI = 1.21, 2.00) in 1998 to 2.46 (95% CI = 1.89, 3.19) in 2004.
The proportion of MoHOP clients failing to return for test results was high and increased substantially between 1997 and 2004. Given the importance of identifying HIV-infected persons, understanding ways to improve return rates for test results is critical, especially for public health officials, clinicians, and researchers implementing and evaluating HIV prevention strategies.
Sex Transm Dis 07/2007; 34(6):397-400. DOI:10.1097/01.olq.0000249757.10209.b3 · 2.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Against the background of debates about expanding HIV testing and counseling, we summarize the evidence on the social and behavioral dimension of testing and its implications for programs. The discrepancy between acceptance of testing and returning for results and the difficulties of disclosure are examined in light of research on risk perceptions and the influence of gender and stigma. We also summarize the evidence on the provision of testing and counseling, the implementation of practices regarding confidentiality and consent, and the results of interventions. We demonstrate that social factors have a considerable impact on testing, show that the services linked to testing are key determinants of utilization, and consider the implications of these findings for HIV testing programs.
American Journal of Public Health 11/2007; 97(10):1762-74. DOI:10.2105/AJPH.2006.096263 · 4.55 Impact Factor
Christopher D Pilcher, Claudia Alquati Bisol, Machline Paim Paganella, Snigdha Vallabhaneni, Leonardo Rapone da Motta, Sergio Kakuta Kato, Rosa Dea Sperhacke, Esper G Kallas, Frederick M Hecht, Ricardo Sobhie Diaz,
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