HIV Testing in Clinical Settings

• CDC recommends that individuals between the ages of 13 and 64 get tested for HIV at least once as part of routine health care and those with risk factors get tested more frequently. A general rule for those with risk factors is to get tested at least annually.
• CDC recently released specific guidance for HIV screening for gay, bisexual and other men who have sex with men (MSM). CDC recommends that clinicians screen asymptomatic sexually active MSM at least annually. Furthermore, clinicians should consider the benefits of more frequent screening (e.g. once every 3 or 6 months) for individual MSM at increased risk for HIV Infection.

How soon can clinicians rule out infection?

CDC recently published research findings that estimate the window period for 20 U.S. Food and Drug Administration (FDA)-approved HIV tests. The study showed that laboratory testing using antigen/antibody tests detects HIV infection sooner than other available tests that detect only antibodies. If a person gets a laboratory-based antigen/antibody test on blood plasma less than 45 days after a possible HIV exposure and the result is negative, follow-up testing can begin 45 days after the possible HIV exposure. For all other tests, CDC recommends testing again at least 90 days after exposure to be sure that a negative test result is accurate.

When should clinicians start treatment for HIV?

Data from a National Institutes of Health sponsored trial indicates there is a clear personal advantage to diagnosis soon after HIV infection and starting therapy early in the course of infection. The study further highlights the importance of routine HIV testing and the potential impact of early treatment on better health outcomes.

Recommendations and Guidelines

• The 2013 U.S. Preventive Services Task Force (USPSTF) recommendations on HIV Testing
• Sexually Transmitted Diseases Treatment Guidelines
• Pre-Exposure Prophylaxis (PrEP)
• Post-Exposure Prophylaxis (PEP)
• Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health Care Settings
  • PDF version

HIV Testing Implementation in Various Settings

Hospitals and Emergency Departments

• Increased HIV testing among hospitalized patients who declined testing in the emergency department. AIDS Care 2016.
• Patient choice in opt-in, active choice, and opt-out HIV screening: randomized clinical trial. BMJ 2016.
• Routine HIV screening in two health-care settings–New York City and New Orleans, 2011-2013. MMWR 2014.

STD Clinics

• The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States. Sex Trans Dis 2014.

Primary Care

• Assessment and improvement of HIV screening rates in a Midwest primary care practice using an electronic clinical decision support system: A quality improvement study. BMC Med Inform Decis Mak 2016.
• Implementation of Routine HIV Testing in Health Care Settings: Issues for Community Health Centers.

Family Planning Clinics

• Integrating routine HIV testing into family planning clinics that treat adolescents and young adults. Public Health Rep 2016.

Substance Abuse Programs

• Implementing HIV testing in substance use treatment programs: A systematic review. J Assoc Nurses AIDS Care 2017.

Pharmacies

• Point-of-care testing for infectious diseases: Opportunities, barriers, and considerations in community pharmacy. J Am Pharm Assoc 2014.

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