November 29, 2012 -- A new set of draft recommendations would make HIV tests as routine as blood sugar screenings or cholesterol tests – at least in theory. Earlier this month, the U.S. Preventive Services Task Force released draft recommendations that HIV testing become routine for everyone between the ages of 15 and 65 – regardless of whether they are considered high risk for infection.
The recommendations are still up for public comment, and are similar to guidelines the Centers for Disease Control and Prevention published in 2006 – but the Preventive Services Task Force's recommendations will carry more weight, according to Kim Toevs, program manager for Multnomah County Health Department's HIV, STD, Hepatitis C Program.
That's because the Affordable Care Act mandates that preventive services recommended by the task force be covered by insurance.
Dr. Douglas Owens, who serves on the task force, said the recommendations were revised partly because of the success of antiretroviral medications – which have not only dramatically expanded the lifespan of people living with HIV, but have recently been shown to reduce the likelihood of transmitting HIV to an uninfected sexual partner.
“It's very evident that if you only screen for people who aware that they're high risk, you're going to miss people,” Owens said.
Toevs said her department has historically focused on testing populations that were considered high risk, but may start working with primary care providers to teach them how to discuss sexual health with their patients, as well as information about treatment and resources for patients who test positive.
“There are people who won't come to us and seek testing because they don't feel they're a priority right now,” Toevs said.
Michael Anderson-Nathe, director of prevention and education services at Cascade AIDS Project, said making HIV screening routine should also reduce the stigma associated with the test – hopefully resulting in more people getting tested at least once during their lifetime, more frequently if they are engaging in high-risk behavior.
Health officials anticipate the home-based HIV tests will increase the number of people being tested. Such tests are available online and can be purchased in some drugstores for between $40 and $60. The test – which does not require a blood draw, but an oral swab – has been used in clinics for several years, but was just recently approved for in-home use.
“Everyone at least once in their life need to get an HIV test,” Toevs said. “Any way that they get that test is a good way to get that test.”
Toevs said the home test is well packaged and a relatively straightforward test to run, and added that early in her work in HIV prevention, people working in clinics took a more “one size fits all” approach to testing and counseling, but are now moving toward more varied and individualized counseling. It's less of a paternalistic, and more of a partner approach, and offering a variety of tests and test settings is part of that: some people might be too stressed out to take an HIV test at home, where others might not be comfortable seeking the test in a clinic.
“The more options we have to access testing, the more we're able to access testing in ways they will feel comfortable,” Anderson-Nathe said.
One down side to the advent of the test, however, is that the Cascade AIDS Project has just recently learned that the Oregon HIV/AIDS hotline – one of the few that are still locally operated – will likely not be funded after next March.
“People who might be getting the preliminary positive result, the hotline would be one of the first places they would call,” Anderson-Nathe said, adding he hopes the state will reconsider its decision not to fund the line, which connects people with information and resources for follow-up testing and treatment. “It's very unfortunate timing in some ways.”
Toevs added that the advent of coordinated care organizations should help people access HIV testing as well as treatment services.
“All the big hospitals in town have had the experience of people coming through the ER system who were very, very sick and very, very expensively sick – folks who had HIV and did not know they had HIV,” Toevs said.
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Image for this story by Stanvanloon (CC BY-SA 3.0) via Wikimedia Commons.
