Persons unaware that they have been infected with HIV account for about 40% of ongoing transmissions of the disease in the United States, according to an article in the December 1, 2017, Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC). The authors analyzed data from CDC's National HIV Surveillance System and found that an estimated 15% of people living with HIV were unaware they carried the infection in 2015. Among the 39,720 people diagnosed with HIV infection in 2015, the median delay in diagnosis was three years. Delay in diagnoses varied significantly among ethnic groups (from 2.2 years among whites to 4.2 years among Asians) and transmission category (from 2.0 years among women who use injectable drugs to 4.9 years among heterosexual men). Rates also differed by group for HIV screening. Nearly three-quarters (71%) of men who have sex with men reported being tested for HIV during the previous year, compared with 58% of people who inject drugs and 41% of heterosexual people at increased risk for HIV infection. At least two-thirds of those who reported not being tested during the previous 12 months said they had visited a healthcare provider during the previous year; about 75% of those people said they had not been offered an HIV test at the doctor's office. For HIV treatment to be effective, CDC said, infections need to be diagnosed as quickly as possible. One of the main reasons cited by men who have sex with men for not being tested was lack of perceived risk. CDC recommends that all people age 13 to 64 be tested at least once as part of routine medical care and those who are at risk for HIV infection be tested at least annually. The actual rates of testing across the country may be lower, CDC noted, because the study was conducted in large metropolitan areas, and studies have shown that HIV infection tends to go undiagnosed at a higher rate in rural areas. While the average time from infection to diagnosis is decreasing, there still exist many missed opportunities for testing, CDC said. Any increase in the length of time individuals are unaware of their HIV infection increases the chance for transmission. “Continued efforts to determine why cases are not being diagnosed soon after infection and to assure implementation of routine and targeted testing can help reduce both the number of persons unaware of their infection and diagnosis delays," CDC said.

HRC Recommends: Screening individuals for HIV is an essential first step to timely diagnosis and treatment. Rapid HIV tests can confirm screening samples in 30 minutes, making diagnostic test results available to patients on-site, within a few hours of their screening. Every state and the District of Columbia has enacted HIV testing laws. Most of these laws are consistent with CDC current recommendations for HIV screening. Risk managers should review their facilities' policies and procedures for compliance with state laws governing HIV screening, consent, reporting, notification, and CDC guidelines. Because the care continuum for HIV patients begins with the diagnosis of HIV infection, risk managers should work with quality improvement professionals in helping their facilities adopt best practices for screening, testing, linkage, retention, and reengagement of patients with HIV.