About one fourth of the one million U.S. residents currently living with HIV are unaware of their HIV infection. A recently published study which looked at routinely offering rapid HIV testing to persons seeking care in hospital emergency departments concluded that all health care facilities (i.e., emergency departments, primary care clinics, community clinics, hospitals in-patient facilities, and urgent care clinics) should offer HIV testing services to patients. Created: 6/22/2007 by MMWR.
Date Released: 8/3/2007. Series Name: A Cup of Health with CDC.
A CUP OF HEALTH WITH CDC
HIV Testing: It Helps to Know
Routine Rapid HIV Testing in Emergency Departments
August 3, 2007
[Announcer] This podcast is presented by the Centers for Disease Control and
Prevention. CDC – safer,
[Matthew Reynolds] Welcome to A Cup of Health with CDC, a weekly broadcast of
MMWR, the Morbidity and Mortality Weekly Report. I’m your host, Matthew
In the United States, approximately one million people are living with HIV. Of
nearly a quarter – that’s about 250,000 people - don’t know
they are infected. When
people get tested for HIV and find out they are infected, they can benefit from
access to live-saving treatment, and can take steps to reduce the risk of infecting
partners. Dr. Jeff Schulden, a research physician with CDC’s HIV/AIDS prevention
program, is one of the authors of a recently published study that looked at the
routinely offering HIV testing to persons seeking care in hospital emergency
departments. He’s here to tell us more about the study’s findings.
Welcome to the show,
[Dr. Schulden] Thanks for having me.
[Matthew Reynolds] Dr. Schulden, tell us more about this study and what you learned.
[Dr. Schulden] In these demonstration projects, we worked with three hospitals
York City, Los Angeles, and Oakland, California to offer HIV testing routinely
seeking care in their emergency departments. We showed that routinely providing
testing in emergency departments is feasible and effective in helping people
HIV status, especially those with limited access to health services. In these
emergency departments, the majority of the more than 34,000 people offered HIV
testing agreed to be tested. Over 9,000 individuals received rapid HIV tests
those, approximately 1% were newly identified as HIV positive. All those newly
diagnosed with HIV were referred to care and at least 88 percent were actually
medical follow up care.
[Matthew Reynolds] Why did you choose emergency departments for these projects?
[Dr. Schulden] Emergency departments are a vital link to populations at high
HIV. They are often the first and only line of health care for many people with
undiagnosed HIV infection.
[Matthew Reynolds] What are the recommendations for offering an HIV test and
is this different from past recommendations?
[Dr. Schulden] Last year, in 2006, CDC announced new HIV testing recommendations
for health care settings. The goal of these recommendations is to make HIV testing
standard, routine part of medical care for all persons between the ages of 13
and for all pregnant women, regardless of perceived risk of HIV. The previous
testing recommendations for health care settings focused on those at perceived
risk for HIV and those receiving care in high HIV prevalence areas. In practice,
old recommendations, patients were often visiting health care facilities without
offered an HIV test. The new recommendations are much more straight forward,
that everyone between the ages of 13 and 64 should be tested, regardless of perceived
[Matthew Reynolds] I recall reading in the past that a person who got HIV testing
would have to go to the clinic get tested and then return to find out the results.
[Dr. Schulden] It has. You’re right. With conventional HIV testing, it
take anywhere from several days to up to two weeks for a person to receive their
test results. Generally, a person would have to return to the facility were they
received the test to get the results. In addition, with conventional HIV testing,
they were performed using a blood sample which was taken with a needle. Now,
rapid HIV testing, which were used in these projects, people can receive their
results in as little as 10 to 20 minutes, which means that in the same visit,
in one visit
where a person receives the test, they actually also get the test result. With
not having to return to get the test results, it means that we as health care
better ensure that people actually get their HIV test result. The other advantage
HIV testing is that they can be performed using finger prick blood or a oral
swab of the
mouth, so they’re much easier to perform and they’re much more acceptable
who might not like needles.
[Matthew Reynolds] Given the relative ease of testing then that you just described,
why wouldn’t some people get tested for HIV?
[Dr. Schulden] Some of the reasons which people report for not getting HIV tested
include not having access to HIV testing services or not knowing where to get
a test, not
having time for an HIV test, or thinking that they don’t need to get an
HIV test. The new
recommendations will make HIV testing much more widely available across health
settings and make it much more straight forward for people to receive an HIV
also hope that by health care providers recommending that all people between
of 13 and 64 receive an HIV test, it will further reduce the stigma and fear
around HIV -
another commonly reported barrier to testing.
[Matthew Reynolds] Let’s say that people take this HIV test and find out
that they are
infected. What actions would you hope they would take?
[Dr. Schulden] By diagnosing people earlier, we can link those who have HIV to
and treatment earlier in the course of their infection. We now have excellent
for people with HIV, allowing them to live long and healthy lives. The earlier
diagnosed with HIV and enrolled in care and treatment, the better their chances
staying healthy longer. In addition, we know that individuals who are aware that
HIV infected are more likely to take steps to protect their partners from getting
you mentioned earlier, it’s estimated that up to one quarter of the more
than one million
people currently living with HIV in the U.S. are not aware of their HIV infection.
[Matthew Reynolds] Besides emergency departments, are there other places where
people can get an HIV test?
[Dr. Schulden] In terms of other clinical settings, we recommend that all health
facilities offer HIV testing services to patients. This would not only include
departments, but also primary care clinics, community clinics, in-patient facilities
hospitals, and urgent care clinics. In addition to health care facilities, many
also have specific HIV voluntary testing and counseling centers where HIV testing
available. These are often run by local HIV service organizations or community
[Matthew Reynolds] If HIV testing is done more often, do you think that that
an effect on people’s attitudes towards being tested?
[Dr. Schulden] Yes. By recommending HIV testing as a routine part of health care
everyone between the ages of 13 and 64, we can help further reduce the stigma
disease. When health care providers offer this test to everyone, it acknowledges
this is a disease which affects all communities and can affect all people. In
CDC has more information about HIV, AIDS, and HIV testing on the CDC web site
www.cdc.gov/hiv, and you can also learn more by calling the CDC information hotline
toll free at 1-800-CDC-INFO.
[Matthew Reynolds] Thank you for taking the time to talk with us today Dr. Schulden.
[Dr. Schulden] Thanks for having me.
[Matthew Reynolds] Well, that’s it for this week’s show. Don’t
forget to join us next
week. Until then, be well. This is Matthew Reynolds for A Cup of Health with
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and your community, please visit www.cdc.gov.