HIV: Improving Patient Screening and Care Retention and Mitigating Legal Risks

December 4, 2017 | Health System Risk Management


HIV infection touches people in every region of the United States. The number of diagnoses per 100,000 people is highest in the South, followed by the Northeast, West, and the Midwest. While more than one-third of the U.S. population lives in southern states, the region accounts for more than half of all HIV diagnoses. See Figure. Diagnoses of HIV Infection by Region (2013).

Healthcare providers should be aware of the prevalence of HIV in their regions. HIV infection is becoming more prevalent in areas with historically low levels of infection as a result of needle sharing, a high-risk behavior among users of injectable opioids.

New treatments for HIV have converted the infection from a death sentence to a manageable chronic condition. Screening for the disease remains an urgent public health measure. However, of the roughly 1.2 million HIV-infected persons living in the United States as of 2016, 1 in 8 was unaware that he or she was infected (CDC "Today's HIV/AIDS"; CDC "HIV Surveillance"). Lack of awareness of their HIV infection is particularly high (44%) among youth between 13 and 24 years of age (Chandwani et al.). High-risk behaviors, notably the use of injectable opioid drugs and unprotected sexual encounters, contribute to the epidemic in the United States (CDC "HIV and Injection Drug Use"). Late diagnosis of HIV infection is also a concern. Patients diagnosed with advanced HIV infection (AIDS) have badly damaged immune systems, placing them at high risk of death from serious illnesses and infections (Ford and Doherty).

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Screening individuals for HIV infection is an essential first step to timely diagnosis and treatment. Unlike decades ago, when individuals had to wait months for the results of screening tests, currently available rapid HIV tests can confirm screening samples in 30 minutes, making diagnostic test results available to patients on-site, within one to two hours of screening (Pilcher et al.).

The U.S. Preventive Services Task Force (USPSTF) recommends that all people ages 15 to 65 years, and all pregnant women, be screened for HIV. In 2006, CDC published revised recommendations for HIV screening of adults, adolescents, and pregnant women in healthcare settings (CDC "Revised Recommendations"). CDC recommends routine voluntary "opt-out" HIV screening as a normal part of clinical practice for all persons ages 13 to 64 years. CDC also recommends including HIV screening in the routine panel of prenatal screening tests for all pregnant women. These recommendations remain unchanged as of 2017 (DiNenno et al.). The screening recommendations are intended for all healthcare settings, including hospital emergency departments (EDs), urgent care clinics, inpatient...

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