Testing and early detection can help

The federal government urged two years ago that routine HIV testing be done on patients — even low-risk individuals — in emergency rooms and doctors’ offices, but this advisory has been largely ignored, according to several researchers attending a conference organized by the Forum for Collaborative HIV Research this week.

The conference brought together about 300 prominent HIV researchers, policymakers, and health-care providers to assess the situation on routine HIV testing.

In 2006, the U.S. Centers for Disease Control and Prevention (CDC) recommended HIV testing for all patients age 13 to 64 being treated in primary care and emergency departments or admitted in hospitals, unless they refuse (called an opt-out procedure).

The CDC said that testing and early detection can help save lives.

Despite this CDC recommendation, barely 1 in 20 patients showing signs of serious illness are tested in hospitals and emergency rooms. Despite the life-threatening nature of HIV, the failure to do routing testing causes it to be under-diagnosed and, consequently, undertreated.

One significant observation was that clinicians have not followed the recommendation.

There are various reasons advanced by the researchers for this failure.

There often are issues regarding payments and reimbursements, availability of counseling services, and informed consent, according to the results of several studies presented.

One survey on a Cleveland-based emergency department was particularly revealing.

* Of 34 staff members who took part (including 5 doctors and 19 nurses), only 9 (slightly above 26 percent) were convinced the facility should offer routine HIV testing.

* Nearly 33% said testing would consume too much of their time.

* 50% said there was no time for adequate counseling to be given.

* 50% expressed concerns there would be too many patients wanting to be tested if routine testing was available.

* About 33% had concerns about confidentiality.

* The researchers asked 256 patients at the same facility whether they wanted HIV testing to be offered. A resounding 88% of the patients answered yes, which contrasted significantly with the health-care professionals’ answers.

Another reason for the widespread neglect in implementing the CDC recommendations is that a number of insurers — including federal programs like Medicare and the Federal Health Employees Benefit — refuse to pay for the tests on low-risk individuals. Testing usually involves a saliva test; if HIV is indicated, a blood test is done to confirm. The cost involved ranges from $80 to $120.

According to the CDC director on HIV prevention, the reimbursement of costs for the test is a major stumbling block in the routine HIV testing program.

State laws may also be a barrier. Ten states have laws that specify, or at least imply, an opt-in procedure, which contradicts the CDC’s opt-out procedure.

Safety Tip:

* Consider getting tested for HIV. Early diagnosis will lead to early treatment and intervention.