CDC Recommendations for HIV Testing of Adults and Adolescents Christina Price, MPH Delta Region AIDS Education and Training Center

I’m so glad we are going to talk about the CDC’s Testing Recommendations. Now I don’t have to worry or think about State Testing Laws! True or False?

Disclaimer CDC recommendations are NOT law Adults Adolescents Pregnant Women Health Care Settings

Recommendations for Adults and Adolescents 1)All persons years of age ROUTINELY & VOLUNTARILY 2)All patients initiating treatment for TB 3)All patients seeking treatment for STDs 4)Repeat screening annually for those known to be at high risk 5)Encourage testing before initiating a new sexual relationship

Rationale Treatment is effective Persons with known status 3.5X less likely to infect Technical advances in testing methods Efforts focused on behavior change have been insufficient Insufficiency of earlier testing practices Numbers are going up among:

Rationale Patients are more likely to accept HIV testing Routine testing reduces stigma Prevention strategies incorporating universal HIV screening have been highly effective

6 ) Opt-out Testing Patient notified an HIV test will be performed Patient may elect to decline or defer testing Consent is inferred unless test is declined Patients notified an HIV test is a routine part of care No requirement for separate written informed consent Patients must specifically decline testing (orally or in writing) to be exempt from having an HIV test “Unless you object, we will test your blood for HIV.”

Consent and Pretest Information Informed orally or in writing Explanation of HIV infection Meanings of positive and negative results Opportunity for questions Must be voluntary Incorporated into patient’s general consent for medical care

7) Diagnostic Testing Signs or symptoms consistent with: HIV infection Opportunistic illness Watch for acute infection Use an RNA test with an antibody test Notify patient of: Plan to test Indication for test Implications of positive and negative test results Offer opportunity to ask questions and decline testing

I have experience using or know how to use an HIV Rapid Test. True or False?

Advances in HIV Testing Technology Six rapid tests now available 4 CLIA waived Require saliva or a drop of blood No specialized equipment Yield results in minutes Sensitivity of % & specificity of %

8) Prevention Counseling Do not require as a part of HIV screening programs Strongly encouraged for persons in high risk settings Time Constraints

Evidence for Adoption of the Revised Recommendations SettingTotal Tested Total Positive % Positive Emergency Departments 64, % Primary Care7, % Mixed Venues58, % Hospital/Ambulatory103, % HIV/STD Clinics5, % Prisons10, % Mental Health Clinics % Total249,3742, % Results from HIV Screening Programs in Healthcare Settings

Recommendations for Pregnant Women

If my pregnant patient/client declines an HIV test I can insist that she take one on behalf of the unborn child. True or False?

9) Universal Opt-Out Screening ALL pregnant women should be screened for HIV during each pregnancy - Voluntary and with the patient’s knowledge - Note in chart if test is declined Address reasons for declining a test

Rationale Allows for benefit of appropriate and timely: Treatment interventions Scheduled cesarean delivery Avoidance of breastfeeding Screening more effective than risk-based testing for: Detecting unsuspected maternal HIV infection Preventing perinatal transmission

Universal Opt-Out Screening Test as early as possible during the pregnancy A second test is recommended if: HIV incidence is high Known high risk for HIV infection Signs or symptoms consistent with acute HIV infection

Postpartum/Newborn Testing If status is unknown at the time of delivery, screen immediately If status is unknown postpartum, screen newborn Inform mother a reactive test indicates she is infected Benefits of neonatal ART prophylaxis best if initiated < 12 hours after birth If an infant is in foster care and status is unknown, inform person authorized to provide consent

10) Communicating Test Results Communicate confidentially and in person Do not use family members as interpreters Follow with linkages to care and support services May communicate without personal contact Advise periodic testing for high risk patients Offer high risk patients prevention counseling

HIV Testing Recommendations Recommendations can be found on the CDC’s website Questions??