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Routine HIV Screening in Health Care Settings David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division.

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Presentation on theme: "Routine HIV Screening in Health Care Settings David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division."— Presentation transcript:

1 Routine HIV Screening in Health Care Settings David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division of Infectious Diseases University of Washington Seattle This project was funded under cooperative agreement number U65/PS000821 from the Centers for Disease Control and Prevention (CDC). Overcoming Barriers to Routine HIV Screening

2 Overcoming Barriers to Routine Screening Summary of Key Recommendations Logistical Issues in Clinical Settings Inadequate Reimbursement for Testing Lack of Adequate Education on HIV Testing State Laws may Conflict with CDC Recommendations Concerns for Cost-effectiveness of Routine Screening

3 Overcoming Barriers to Routine Screening Summary of Key Recommendations Logistical Issues in Clinical Settings Inadequate Reimbursement for Testing Lack of Adequate Education on HIV Testing State Laws may Conflict with CDC Recommendations Concerns for Cost-effectiveness of Routine Screening

4 Overcoming Barriers to Routine Screening Logistical Issues in the Clinical Setting

5 Potential Barriers to Routine Screening in Multiple Health Care Settings

6 Analysis of Barriers to Routine Screening in Multiple Health Care Settings Source: Burke RC, et al. AIDS. 2007;21: 1617-24. Prenatal Emergency Department Other Medical Settings

7 Analysis of Barriers to Routine Screening in Multiple Health Care Settings Source: Burke RC, et al. AIDS. 2007;21: 1617-24. Prenatal Emergency Department Other Medical Settings Insufficient Time Burdensome Consent Process Perception that Clients had Low HIV Risk Insufficient Time Burdensome Consent Process Perception that Clients had Low HIV Risk

8 Overcoming Logistical Issues in Clinical Settings Source: CDC. MMWR 2006;55(no. RR-14):1-17. Prevention Counseling Not Required in Conjunction with HIV Screening Routine HIV Screening for All Patients Aged 13-64 Written Consent Should Not be Required

9 Overcoming Logistical Issues in Clinical Settings Source: Zetola NM, et al. PLOS. 2007;21:1617-24.

10 Impact of Simplified HIV Consent Process on HIV Testing Rates Source: Zetola NM, et al. PLOS. 2007;21:1617-24.

11 Impact of Simplified HIV Consent Process on HIV Testing Rates Source: Zetola NM, et al. PLOS. 2007;21:1617-24.

12 Overcoming Barriers to Routine Screening Summary of Key Recommendations Logistical Issues in Clinical Settings Inadequate Reimbursement for Testing Lack of Adequate Education on HIV Testing State Laws may Conflict with CDC Recommendations Concerns for Cost-effectiveness of Routine Screening

13 Reimbursement for HIV Testing Source: CDC. MMWR 2006;55(no. RR-14):1-17.

14 Reimbursement for HIV Testing 2009 Medicare & Medicaid Coverage www.cms.hhs.gov/mcd/viewtrackingsheet.asp?from2=viewtrackingsheet.asp&id=229&

15 Reimbursement for HIV Testing American Academy of HIV Medicine Coding Guidelines http://www.aahivm.org/

16 Reimbursement for HIV Testing American Academy of HIV Medicine Coding Guidelines http://www.aahivm.org/ CPT Codes

17 Overcoming Barriers to Routine Screening Summary of Key Recommendations Logistical Issues in Clinical Settings Inadequate Reimbursement for Testing Lack of Adequate Education on HIV Testing State Laws may Conflict with CDC Recommendations Concerns for Cost-effectiveness of Routine Screening

18 Lack of Adequate Education on HIV Testing Lack of Awareness of CDC Recommendations for HIV Screening Misperception Regarding Client Acceptance Lack of Training on Interpreting Results

19 Educational Resources for HIV Testing CDC HIV Testing in Healthcare Settings Website http://www.cdc.gov/hiv/topics/testing/healthcare/index.htm

20 Educational Resources for HIV Testing AIDS Education and Training Centers (AETC) http://www.aids-etc.org/ Regional AETCsAETC National Resource Center

21 Educational Resources for HIV Testing National HIV/AIDS Clinicians’ Consultation Center http://www.nccc.ucsf.edu/home

22 Overcoming Barriers to Routine Screening Summary of Key Recommendations Logistical Issues in Clinical Settings Inadequate Reimbursement for Testing Lack of Adequate Education on HIV Testing State Laws may Conflict with CDC Recommendations Concerns for Cost-effectiveness of Routine Screening

23 State Specific HIV Testing Laws

24 State Specific HIV Testing Laws Variable Compatibility with CDC Recommendations

25 Information on State Specific HIV Testing Laws NCC Compendium of State Testing Laws http://www.nccc.ucsf.edu/consultation_library/state_hiv_testing_laws/

26 Overcoming Barriers to Routine Screening Summary of Key Recommendations Logistical Issues in Clinical Settings Inadequate Reimbursement for Testing Lack of Adequate Education on HIV Testing State Laws may Conflict with CDC Recommendations Concerns for Cost-effectiveness of Routine Screening

27 Overcoming Barriers to Routine Screening Summary of Key Recommendations Logistical Issues in Clinical Settings Inadequate Reimbursement for Testing Lack of Adequate Education on HIV Testing State Laws may Conflict with CDC Recommendations Concerns for Cost-effectiveness of Routine Screening

28 Cost Effectiveness of HIV Screening in HAART Era Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85.

29 Cost Effectiveness of HIV Screening in HAART Era Study Background Markov decision model - Used to estimate health benefits and costs of performing voluntary HIV screening in health care settings Model factors - Voluntary HIV screening of a population - Natural history of HIV and AIDS - Costs and health consequences of transmission of HIV - Costs and health consequences of HAART Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85.

30 Cost Effectiveness of HIV Screening in HAART Era Results: Analysis of One Time Screening Sensitivity Analysis of the Effect of the Prevalence of Unidentified HIV on the Incremental Cost-Effectiveness of One-Time Screening, as Compared with Current Practice New Sexual Relationship Cost and benefit to partner excluded Prevalence of Unidentified HIV (%) Incremental Cost-Effectiveness of Screening ($/quality-adjusted life-years) Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85. Figure Reproduced with permission from the Massachusetts Medical Society

31 Cost Effectiveness of HIV Screening in HAART Era Results: Analysis of One Time Screening Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85. Figure Reproduced with permission from the Massachusetts Medical Society Sensitivity Analysis of the Effect of the Prevalence of Unidentified HIV on the Incremental Cost-Effectiveness of One-Time Screening, as Compared with Current Practice New Sexual Relationship Cost and benefit to partner excluded Prevalence of Unidentified HIV (%) Incremental Cost-Effectiveness of Screening ($/quality-adjusted life-years)

32 Cost Effectiveness of HIV Screening in HAART Era Results: Analysis of One Time Screening Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85. Figure Reproduced with permission from the Massachusetts Medical Society Sensitivity Analysis of the Effect of the Prevalence of Unidentified HIV on the Incremental Cost-Effectiveness of One-Time Screening, as Compared with Current Practice New Sexual Relationship Cost and benefit to partner excluded Cost and benefit to partner included Prevalence of Unidentified HIV (%) Incremental Cost-Effectiveness of Screening ($/quality-adjusted life-years)

33 Cost Effectiveness of HIV Screening in HAART Era Conclusion Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85. “… the cost-effectiveness of screening is well within the range of that of other commonly accepted health care interventions.”

34 Acknowledgement The project was funded under cooperative agreement number U65/PS000821 from the Centers for Disease Control and Prevention (CDC).

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