How useful is universal screening for HIV infection? A review of the evidence

Routine HIV Testing and Outcomes: A Population-Based Cohort Study in Taiwan

INTRODUCTION

Routine HIV testing is expected to facilitate early diagnosis and treatment. Nevertheless, to date, limited data are available on the presumed benefit of early detection with improved outcomes through routine HIV testing.

METHODS

This study was based on the Taiwan national HIV/AIDS registry, with follow-up data validated through December 31, 2014. Outcomes of people diagnosed with HIV infection through the routine (routinely offered in specific settings, opt-out) versus through nonroutine (individual risk-based) testing were compared. The main outcomes of the study were late diagnosis, HIV-related mortality, and all-cause mortality. Individuals were matched by year of HIV diagnosis and adjusted for age, sex, transmission routes, and SES. Analyses were conducted in 2019-2020.

RESULTS

This study included all 28,674 people diagnosed with HIV infection during 1986-2014 (8,431 [29%] by routine testing, 18,305 [64%] by individual risk-based testing) with a mean follow-up time of 6.2 years. Routine testing was associated with an 80% lower likelihood of late HIV diagnosis (AOR=0.20, 95% CI=0.18, 0.23, p<0.001), a 37% lower HIV-related mortality (adjusted hazard ratio=0.63, 95% CI=0.53, 0.75, p<0.001), and a 27% lower all-cause mortality (adjusted hazard ratio=0.73, 95% CI=0.67, 0.79, p<0.001).

CONCLUSIONS

Routine HIV testing was associated with highly favorable outcomes, including decreased late diagnosis, lower HIV-related mortality, and lower all-cause mortality, among people diagnosed with HIV infection. Under universal health coverage, expanding routine HIV testing in well-targeted settings may improve both HIV epidemic control for society and clinical outcomes for people living with HIV.

Routine Inpatient Human Immunodeficiency Virus Screening: Missed Prevention Opportunities

PURPOSE/OBJECTIVES

This article reviews the current guidelines for human immunodeficiency virus (HIV) screening among inpatients and explores adherence to the guidelines and barriers to their implementation.

BACKGROUND

In 2006, the Centers for Disease Control and Prevention released updated recommendations suggesting HIV screening for all patients in all healthcare settings.

DESCRIPTION

A nonsystematic review of current HIV screening guidelines, as well as research and nonresearch literature, addressing rates of inpatient screening was performed.

RESULTS

Between 2000 and 2010, there was a significant increase in testing in healthcare settings. Despite these advances, 10 years after the updated Centers for Disease Control and Prevention guidelines were released, many hospitals still have not fully implemented the recommendations. Barriers to implementation of the guidelines include provider misconceptions and lack of time and reimbursement.

CONCLUSIONS

Screening for HIV identifies new infections, reduces transmission, prevents complications, and encourages a discussion about prevention. Increasing adherence to screening recommendations can help prevent new cases and disease progression. The nursing focus on prevention makes clinical nurse specialists and other advanced practice registered nurses uniquely positioned to increase screening. Clinical nurse specialists should implement research projects to understand adherence in their facilities and identify and address site-specific barriers. Quality improvement programs can then be implemented to improve screening rates.