Targeting HIV better than broad screening

A program targeting people most likely to be infected with HIV and offering counseling to prevent further infection would be far more effective than the government's recommendations for mass testing, U.S. researchers said on Monday.

They said the U.S. Centers for Disease Control and Prevention's recommendations for widespread HIV testing of those aged 13 to 64, regardless of risk, would cost $864 million a year.

The CDC's recommendations for mass screening would not require counseling, and patients could opt out of testing if they chose.

A plan that targets those at high risk and offers counseling services could pick up more than three times as many people with HIV and could prevent four times as many new infections -- all for the same price, according to an analysis by David Holtgrave, an expert on HIV prevention at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

"It's really a question of which policy would be more effective," said Holtgrave, whose study appears in the June edition of the journal PLoS Medicine.

His analysis found that the CDC's new testing strategy -- announced in September -- could diagnose nearly 57,000 cases of HIV in a one-year period.

But a strategy that zeros in on likely targets of HIV infection -- by geography, health care setting or risky behavior -- would identify 188,000 people with the disease out of an estimated 250,000 to 300,000 people in the United States living with HIV but not knowing they are infected.

"You would do much better in terms of diagnoses," Holtgrave said in an interview.

'TARGETED SCENARIO'

He said the targeted approach would focus testing mainly on clinics and emergency departments that treat the uninsured who might lack access to regular health care, on areas with a higher-than-normal percentage of HIV infection or on a physician's assessment of risky behavior.

It also would use counseling as a means of preventing the spread of HIV infection.

"When we compared opt-out testing to the targeted scenario, it seems like the targeted scenario works better. The cost parameters are the same, but you wind up diagnosing more people and preventing more infections," Holtgrave said.

In September, the CDC replaced its 1993 recommendations on HIV testing in health-care settings in a bid to make HIV screening a part of routine medical care and to boost diagnosis of HIV infection among pregnant women.

CDC's previous HIV testing recommendations for health-care settings called for routine testing for people at high risk, and for everyone -- regardless of risk -- in settings with HIV prevalence above 1 percent.

CDC has said its revised recommendations are designed to simplify the testing process and remove barriers to testing.

"Our point of view is this is not a question of either-or. You really do need both approaches. You need targeted risk based-testing, and you need broader screening," said Dr. Bernard Branson of CDC's division of HIV/AIDS prevention.

"Risk-based screening misses about half of HIV-infected people in the health care setting," he said in a telephone interview.

"Providers are often unwilling to do risk assessments and patients are often unwilling to be labeled as at high risk for HIV. Those features have told us that risk-based screening will be insufficient to find all of the people that will be HIV-infected," he said.

CDC's new recommendations do not alter current recommendations on HIV counseling and testing in nonclinical settings, such as community centers or outreach programs.

source : news.yahoo.com