CDC Guidelines

In 2011, the Centers for Disease Control and Prevention (CDC) reported that 1,178,350 Americans were living with HIV in 2008; of those, approximately 240,000 were unaware of their HIV-positive status. Increasing the number of persons who are aware of their status is a critical strategy for preventing HIV infections.* People who are infected with HIV but not aware of it are not able to take advantage of the therapies that can improve their health, extend their lives and reduce their risk of transmitting HIV to their sex or drug-use partners. Knowing whether one is positive or negative for HIV confers a benefit on the individual and society at large.

The goal of screening is to identify asymptomatic individuals early in the course of the disease. Early diagnosis and linking patients to health care has been shown to improve survival and the quality of life, as well as reducing the risk of HIV transmission. The Revised CDC Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings include the following guidance for all health-care providers in the public and private sectors, including those working in hospital emergency departments, urgent care clinics, inpatient services, substance abuse treatment clinics, public health clinics, community clinics, correctional health-care facilities, and primary care settings:

Screening patients in all health-care settings

• HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
• Persons at high risk for HIV infection should be screened for HIV at least annually, i.e.:
  • persons who have shared drug injection equipment
  • persons who have had unprotected oral, anal or vaginal sex with: high-risk, multiple or anonymous partners.
  • persons who have been diagnosed or treated for hepatitis, tuberculosis or sexually transmitted disease.
• Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
• Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings.

Screening pregnant women

• HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.
• HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
• Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
• Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women.

The above recommendations may conflict with existing institutional policies and state regulations. Implementation of CDC guidelines may vary by institution and jurisdiction; healthcare providers will need to keep abreast of changes as policy and regulations are amended. Some areas of potential conflict include: consent for HIV screening, documentation and reporting of screening results, pretest counseling, parental consent for minors, prenatal testing, etc..

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