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Targeting
HIV Better than Broad Screening: Study |
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A study by Dr. David
Holtgrave, an expert on
HIV prevention at the Johns Hopkins
Bloomberg School of Public Health-Baltimore, says a program targeting people
at high risk for HIV that offers counseling would be more effective than
routine testing of those ages 13 to 64 regardless of risk, as recommended by
CDC. The CDC plan does not require counseling and allows patients to refuse
to be tested.
The study said implementing CDC's plan would cost $864 million a year.
Holtgrave maintains that for the same price, a plan targeting those at high
risk that offers counseling could detect more than three times as many
HIV-positive people and prevent four times as many new infections.
Holtgrave's analysis found that CDC's testing strategy could diagnose about
57,000 HIV cases in a one-year period. However, a strategy that focuses on
likely HIV patients - by geography, health care setting or risk behavior -
would identify 188,000 people with HIV out of the estimated 250,000-300,000
people in the United States who have HIV but do not know it, according to
Holtgrave.
Holtgrave said the targeted approach would focus testing mainly on clinics
and emergency departments that treat the uninsured, on areas with a
higher-than-normal percentage of HIV infection, or on physicians'
assessments of risky behavior. It would use counseling as a means of
preventing the spread of HIV.
CDC's 1993 guidelines called for routine testing of high-risk patients and
of patients in settings with an HIV prevalence of greater than 1 percent.
Its updated regulations, announced in September, are designed to simplify
the testing process and remove barriers to screening toward the goals of
making HIV testing a part of routine care and of diagnosing more
HIV-infected pregnant women.
"Our point of view is this is not a question of either-or," said Dr. Bernard
Branson of CDC's division of HIV/AIDS prevention. "You really do need both
approaches. You need targeted risk-based testing, and you need broader
screening. Risk-based screening misses about half of HIV-infected people in
the health care setting."
"Providers are often unwilling to do risk assessments, and patients are
often unwilling to be labeled as at high risk for HIV," Branson said in a
telephone interview. "Those features have told us that risk-based screening
will be insufficient to find all of the people that will be HIV-infected."
The full study, "Costs and Consequences of the US Centers for Disease
Control and Prevention's Recommendations for Opt-Out HIV Testing," appears
in the online journal Public Library of Science: Medicine (2007;4(6);e194
doi:10.1371/journal.pmed.0040194).
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Reuters (06.11.07)::
Julie Steenhuysen |
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We are providing the above information as a public
service only. Providing synopses of key scientific articles and lay
media reports on HIV/AIDS, other sexually transmitted diseases
does not constitute endorsement. The above summaries were prepared
without conducting any additional research or investigation into the
facts and statements made in the articles being summarized, and
therefore readers are expressly cautioned against relying on the
validity or invalidity of any statements made in these summaries. This
CDC HIV/STD/TB Prevention News
Update also includes information from CDC and
other government agencies, such as background on MMWR articles, fact
sheets and announcements. |
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