HIV Testing: Linking Unaware Into Care

HIV Testing: Linking Unaware Into Care

December 1, 2010
Patient and medical staff person

Significant Ryan White technical assistance services have been put in place in recent years to expand HIV testing and counseling in medical care settings. The challenge being faced is as follows: around 1 in 5 individuals living with HIV in America do not know they are infected and significant numbers of infected individuals enter care late, within one year of an AIDS diagnosis. Likely, these individuals are not getting tested in their medical care encounters or are not accessing care because they are underserved.

HIV/AIDS programs have known these facts for many years and—as described below—have been changing HIV/AIDS services on many levels to expand HIV testing and link previously untested and unaware people into care.  The National HIV/AIDS Strategy, released in 2010 (and updated for 2020), calls for expanded HIV testing as do Federal HIV testing guidelines issued in 2006 that include recommendations like HIV testing as a routine part of primary medical care and regular testing unless patients chose to opt-out.

Many Ryan White activities to expand HIV testing in medical care settings were featured at the 2010 Ryan White Grantee Meeting and are available at the TARGET Center (search HIV testing).

HHS’s Health Resources and Services Administration (HRSA) has also issued policy changes in support of Ryan White legislative language that allows grantees to use Ryan White funds to broaden HIV testing if the focus is on engaging people in care and if funds avoid duplication of existing testing and counseling services. 

TA on HIV Testing

In 2007, HRSA created new technical assistance services to expand HIV testing and counseling in medical care settings, in partnership with the Centers for Disease Control and Prevention (CDC). Training activities are being carried out by the AIDS Education and Training Centers (AETCs), the clinician-training arm of Ryan White. As of mid-2010, AETCs have conducted over 3,100 trainings for nearly 50,000 providers to teach them how to do routine HIV testing according to federal guidelines. Over 500 sites have implemented routine testing in: hospital emergency rooms/urgent care clinics, STD and prenatal clinics, HRSA Health Centers, and inpatient acute care facilities.

Under a related project, AETCs partnered with the CDC, HRSA's Bureau of Primary Health Care, and the National Association of Community Health Centers to conduct 6 pilot studies to create models for integrating HIV testing in Health Center primary care settings (see Implementation of Routine HIV Testing in Health Care Settings: Issues for Community Health Centers). Those pilots developed testing algorithms and patient flow charts, collected data, and trained staff.

The HRSA/CDC HIV testing initiative has produced over 100 AETC HIV testing resources.

Testing Work in the Field

Yet more HIV testing expansion activities are underway in the field, under the direction of various Ryan White agencies. Many efforts include participation from AETCs. For example:

  • A statewide Test Texas HIV Coalition seeks to “encourage the implementation of routine opt-out HIV testing in medical settings.” Project partners include the regional AETC, the State health department, and others.
  • Another initiative involves HIV testing in the dental chair, which resulted in an HIV Testing in the Dental Chair TA Manual.  This project was also the subject of a September 2010 AETC Feature Story.

These two, along with many others, were presented as workshops and posters at the 2010 Ryan White Grantee Meeting and can be found online at the TARGET Center (search HIV testing).

Study Examines Attitudes on Prenatal HIV Testing

HRSA’s HIV/AIDS Bureau funded an exploratory study to determine women’s concerns about routine prenatal HIV testing, and the findings have been recently published in Maternal and Child Health Journal, and the pre-print e-publication is available.

The study was conducted by the School of Nursing at the University of Medicine and Dentistry of New Jersey and involved focus group discussions with women in clinics in four states that addressed health care provider approaches to routine prenatal HIV testing.  The study analyzed the women’s concerns as well as their suggestions for addressing those concerns about universal routine prenatal HIV testing.  The research indicated that women will be more comfortable with routine prenatal HIV testing:

  • If they are fully informed and knowledgeable about the rationale for HIV testing during pregnancy and their right to decline, and
  • If testing is carried out in a confidential and supportive health care environment.

Pre- and post-implementation comparisons show that the program has increased treatment adherence, improved clinical outcomes, and reduced HIV-related