Many People Disregard Advice to Get HIV Tests, Studies Show

By David Brown
Washington Post Staff Writer
Friday, November 21, 2008

Two years after the federal government recommended that patients in emergency rooms and doctors' offices be routinely tested for HIV, the advice is generally not being followed, according to a large number of studies presented this week at a conference in Arlington.

Only about 5 percent of patients with evidence of serious illness are being routinely tested in hospital emergency rooms for the virus that causes AIDS, said Veronica Miller, director of the Forum for Collaborative HIV Research, an independent public-private partnership based at the George Washington University School of Public Health and Health Services.

"HIV is a life-threatening disease that is so grossly underdiagnosed and undertreated in this country," Miller said in a briefing on the two-day Summit on HIV Testing.

In 2006, the Centers for Disease Control and Prevention recommended that everyone age 13 to 64 be routinely tested in medical encounters, with the choice to opt out if they want.

Among the many reasons for the general neglect of the recommendations, the studies indicate, are the perception of many clinicians that it takes too much time and the reluctance of some insurers to pay for the tests.

Point-of-service testing consists of a saliva test, followed if possible by a confirmatory blood test. If a patient is charged, the cost is about $80 to $120.

"Reimbursement is a major barrier to routine testing," said Kevin Fenton, director of HIV prevention at the CDC.

In urban emergency rooms, infection rates run from 0.5 to 1 percent of people tested, although many choose not to be tested, studies presented at the conference found.

When the emergency department at George Washington University Medical Center began offering the saliva test, 0.8 percent of those accepting were infected, far below the District's estimated 5 percent HIV prevalence rate.

About half the people from the District's wealthiest ward opted out of testing, compared with one-third of those from the poorest ward. The researchers speculated that the reason the infection rate was unexpectedly low may be that HIV prevalence is higher in people who decline testing.

At Hahnemann University Hospital in Philadelphia, where trained counselors offered rapid testing to emergency room patients in an interaction that lasted slightly more than five minutes, 83 percent of patients said yes. Half were women, 80 percent were black, and the average age was 36. About one-quarter had never been tested, and 0.7 percent were infected.

The research also suggests that routine testing, if implemented, would detect the infection at a much earlier stage in many patients.

At John H. Stroger Jr. Hospital of Cook County, in Chicago, about 2,000 patients who went to the emergency room and were ill enough to be admitted were offered HIV tests. Just under 1 percent were infected, and more than 90 percent of them had CD4 cell counts below 200. At that level, a person has severe immune system damage and is considered to have AIDS.

In the two years before the test, those patients had visited the emergency room three times on average -- each visit a missed opportunity to diagnose their infection earlier.

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