Who Should Get Tested For HIV?

Universal and targeted HIV screening show similar effectiveness

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Early detection of human immunodeficiency virus (HIV) is extremely important because disease management will be easier, more efficient and cost less. But how do you know if you should get tested?

A recent study compared the effectiveness of targeted HIV screening (testing those at risk for HIV) versus universal HIV screening (testing everyone) in detecting new cases of HIV in an emergency department setting.

The findings showed that universal screening was able to detect more new cases of HIV than targeted screening despite the wide risk criteria for targeting and equal resources used for both groups. However, the authors believe this may have been due to the larger group of people who were universally tested.

The authors concluded that targeted HIV screening did not offer an increase in detection rates or a decrease in amount of tests performed.

"Ask your doctor if you should be tested for HIV."

This study was conducted by Michael S. Lyons, MD, MPH, professor in the Department of Emergency Medicine and Director of the Early Intervention HIV Program at the University of Cincinnati College of Medicine in Ohio, and colleagues.

Public health advocates have argued that universal HIV screening is the most effective way to detect new cases of HIV, but the authors believe that universal screening costs more money, requires more tests and is hard to enforce.

Targeted HIV screening uses fewer tests, but previous studies have found that this strategy is not as effective in identifying new cases. The authors study believe this might be due to healthcare professionals using a too-narrow spectrum of risk criteria, and health centers not having enough resources to provide testing to all patients.

The researchers recruited patients from a total of 9,572 visits between January 2008 and December 2010 to an emergency department in an area where rates of HIV were low. These patients were between the ages of 18 and 64, were not knowingly infected with HIV and had not been previously offered HIV testing on the day they were recruited.

These patients were assigned to either targeted screening or universal screening.

The universal screening group was approached at random by counselors who encouraged general medical testing.

Hospital notes, electronic medical records and staff referrals were used to evaluate risk in the targeted screening group. The researchers used over 50 different criteria for risk indication, and patients were considered at risk if they fit at least one criterion.

The target risk criteria included: doctor-identified signs and symptoms of HIV, doctor or counselor-identified risk behaviors, mental illness, homelessness, violence, substance use, prison sentence, pregnancy or STD (sexually transmitted disease) exposure or infection.

The patients who did not readily exhibit any of the target risks were asked if they had ever injected drugs, had sex with a man (if the patient was male), exchanged sex for money or drugs or had sex with a partner who was infected or at risk for HIV; or if in the past two years they had used methamphetamine or cocaine, been diagnosed with an STD, had sex while using alcohol or drugs or had sex with more than one partner.

There were 4,692 patients selected for the universal screening group, and 41 percent of the patients consented to screening. The researchers detected six new cases of HIV, which was 0.31 percent of that group.

In the targeted screening group, 4,880 people were selected, but 1,813 people did not exhibit any need for testing. Out of the 3,067 patients remaining in the targeted testing group, 47 percent consented and researchers detected three new cases, which was 0.22 percent of that group.

More of the targeted patients consented to take a test, but more patients in the universal testing group were tested overall. The authors thought that the proportioned results were too similar to determine whether universal or targeted screening was more effective.

The authors agree that the recommendation for universal screening is justified, but they still think that enforcement remains a large challenge because resources are often not sufficient to support the amount of tests needed for the universal strategy.

The authors mentioned a few limitations.

First, they suggested that these specific results may not apply to other emergency departments or other types of healthcare centers that have a different focus, approach and method to disease control.

In addition, the authors explained that the specific screening model influenced the results, but this model is one of many.

This study was published in July in the Journal of Acquired Immune Deficiency Syndromes.

The Ohio Department of Health and the Ryan White program provided funding for this project. Dr. Lyons also received funding from Gilead Sciences, Inc.

Review Date: 
August 28, 2013
Last Updated:
August 29, 2013