July 21, 2010

HIV Screening in Health Care SettingsSome Progress, Even More Questions

Author Affiliations

Author Affiliations: Departments of Emergency Medicine (Drs Merchant and Waxman) and Community Health (Dr Merchant), Warren Alpert Medical School of Brown University, Providence, Rhode Island.

JAMA. 2010;304(3):348-349. doi:10.1001/jama.2010.996

In 2006, the US Centers for Disease Control and Prevention (CDC) issued revised recommendations for HIV diagnostic testing and screening in health care settings.1 With these recommendations, the CDC advised that all 13- to 64-year-old patients in US health care settings undergo nontargeted screening for HIV—that is, be tested without regard to their actual or perceived risk for HIV and without regard to signs or symptoms of HIV infection. To facilitate large-scale screening, the CDC proposed fundamental changes to HIV testing methods. The CDC recommended that (1) an opt-out approach should be used to introduce HIV testing (patients are informed that they will be tested for HIV unless they decline); (2) patient permission for HIV testing should not be given through a separate signed consent form but can be considered part of the general medical consent for care (either implicitly or explicitly stated); and (3) HIV prevention counseling does not need to be performed at the time of testing.2

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