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In 2006, the CDC recommended routine HIV testing in healthcare settings (http://viajwat.ch/We68T9). Even though this recommendation was evidence based, its adoption has been slow. Consequently, HIV infection is still diagnosed late in the course of disease in many patients in the U.S.
To examine adherence to this 2006 recommendation, investigators analyzed data obtained as part of the CDC's Medical Monitoring Project Provider Survey, conducted from June through September 2009. A total of 735 HIV care providers returned the survey. Of the 506 providers who also had HIV-uninfected patients in their practice, 60% reported offering HIV screening to all patients aged 13 to 64 (except those known to be HIV infected), in accordance with the CDC recommendation. However, 31% offered HIV testing mainly to those at high risk, and 9% did not offer it at all. In multivariate analysis, provider characteristics associated with offering routine HIV testing to all patients were profession (i.e., nurse practitioner, rather than physician), age <50, and black race. Providers who had ≥75 HIV-infected patients in their practice were also more likely to offer such testing.
McNaghten AD et al. Routine HIV testing among providers of HIV care in the United States, 2009. PLoS ONE 2013 Jan; 8:e51231. (http://dx.doi.org/10.1371/journal.pone.0051231)
Comment
Few of us would argue that incorporating HIV screening into routine medical care is not cost effective. Thus, it is quite surprising to see the finding that only 60% of clinicians who provide HIV care and also have HIV-uninfected patients in their practice routinely offer this screening. To quote John F. Kennedy, “If not us, who? If not now, when?”