CDC Testing Push Increased HIV Diagnosis

SUMMARY A CDC effort to promote HIV testing begun in 2007 led to nearly 2.8 million tests and more than 18,000 new diagnoses, according to MMWR.

By Liz Highleyman

Four years ago the U.S. Centers for Disease Control and Prevention (CDC) started the Expanded HIV Testing Initiative (ETI), concerned than an estimated 20% of people with HIV were unaware of their status. In 2006 the CDC recommended routine screening in healthcare settings for people age 13-64 years, and the program was launched in October 2007.

The initiative provided $111 million to fund expanded HIV screening and linkage to care at 25 health departments with more than 1300 testing venues, focusing on those serving populations disproportionately affected by the HIV/AIDS epidemic, and in particular blacks/African-Americans.

As described in the June 24, 2011, Morbidity and Mortality Weekly Report, Abigail Viall from the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention and colleagues collected data derived from the initiative between October 2007 and September 2010.

Results

	Since its 2007 launch 2,786,739 HIV tests were performed at the funded facilities.
	29,503 tests (1.1%) were HIV positive.
	18,432 (0.7%) of all tests resulted in a new HIV diagnosis (nearly 40% of people testing positive already knew they were infected).
	Men accounted for 55% of all tests performed and 72% of new diagnoses.
	Blacks accounted for 60% of all tests and 70% of newly diagnoses.
	Blacks were 1.6 times more likely to be diagnosed with HIV than whites and Hispanics/Latinos (0.8% vs 0.5% vs 0.5%, respectively).
	90% of tests were done in clinical settings, but 81% of new diagnoses came from these settings:
	Emergency departments: 8% of testing venues, performing 30% of all tests, and identifying 32% of all new diagnoses. Sexually transmitted disease clinics: 21% of venues, 21% of all tests, and 20% of new diagnoses. Substance abuse clinics: 6% of all venues but only 0.9% of tests and new diagnoses.
	The most common non-clinic settings were community-based organizations, performing 6% of tests but identifying 11% of new diagnoses.
	93% of people tested in clinical settings received their results, compared with 84% in non-clinical setting.
	12,711 newly diagnosed people (75% overall) were successfully linked to HIV primary care.
	78% of people diagnosed in clinical settings were linked to follow-up care, compared with 63% diagnosed in non-clinical settings.

"Through expanded HIV testing activities, substantial numbers of persons previously unaware of their HIV infection were identified and linked to care," the study authors concluded.

"Ultimately, achieving the broader National HIV/AIDS Strategy prevention goals of reducing HIV incidence and transmission will require more than strengthening mechanisms for identifying persons with undiagnosed HIV infection and linking these persons to care," according to an accompanying editorial note.

"Persons with HIV must enter and progress along a spectrum of care to reduce their risk for transmission: ETI focused on the first two elements of this spectrum (diagnosis and linkage to care)," the editors continued. "However, for efforts like ETI to translate into better individual and population-level outcomes, persons infected with HIV must be engaged and retained in care, receive and adhere to effective treatment with HAART to maximize viral load suppression, and have access to ongoing prevention and support services, including risk-reduction counseling and other evidence-based behavioral interventions, partner services, substance use and mental health treatment, and case management."

7/5/11

Reference
AH Viall, SW Dooley, BM Branson, et al. Results of the Expanded HIV Testing Initiative -- 25 Jurisdictions, United States, 2007-2010. Morbidity and Mortality Weekly Report 60(24):805-810 (free full text).