June 24, 2011
Approximately 20% of the estimated 1.2 million persons living with human immunodeficiency virus (HIV) infection in the United States at the end of 2008 were not aware of their infection.1 Testing, diagnosis, medical care, treatment with highly active antiretroviral therapy (HAART), and access to prevention services soon after HIV infection can prevent morbidity and mortality and reduce a person's risk for transmitting HIV.2-6 In 2006, CDC recommended screening patients aged 13-64 years for HIV infection in health-care settings that have a prevalence of undiagnosed HIV infection of ≥0.1%.7 In October 2007, CDC initiated the Expanded HIV Testing Initiative (ETI), through which it funded 25 health departments to facilitate HIV screening and increase diagnoses of HIV infections and linkage to care among populations disproportionately affected by HIV, especially non-Hispanic blacks. This report describes the results of that effort. Annual progress reports designed to provide data specific to ETI indicated that 2,786,739 HIV tests were conducted, of which 29,503 (1.1%) were positive and 18,432 (0.7%) resulted in new HIV diagnoses. Blacks accounted for 1,411,780 (60%) of tests and 11,638 (70%) of new HIV diagnoses. Clinical settings comprised at least 75% of the 1,331 testing venues and accounted for 90% of all tests and 81% of all new HIV diagnoses. Based on follow-up data available for 16,885 persons with new HIV diagnoses, 12,711 (75.3%) were linked successfully to HIV primary care. Through expanded HIV testing activities, substantial numbers of persons previously unaware of their HIV infection were identified and linked to care. Health departments should continue to partner with clinical-care providers to provide routine HIV screening, especially in populations disproportionately affected by HIV.
In October 2007, CDC launched ETI to supplement existing HIV testing efforts and improve the availability and accessibility of HIV testing services, facilitate adoption of HIV screening in health-care settings, and increase identification of undiagnosed HIV infection in populations disproportionately affected by HIV, particularly blacks. During the 3-year program period, CDC provided an additional $111 million to health departments in 25 U.S. jurisdictions* that had reported 140 or more AIDS diagnoses among blacks in 2005. Health departments were required to focus at least 80% of their activities on promoting opt-out HIV screening in high-morbidity clinical settings; they had the option of directing up to 20% of their efforts toward supporting innovative methods to increase targeted HIV testing among high-risk populations (e.g., social networking approaches to increase testing among men who have sex with men). In addition, health departments had to ensure that all persons newly diagnosed with HIV† through ETI received their HIV tests results, were linked to medical care,§ and were referred for partner services. Semiannually, health departments used progress report forms developed by CDC to report ETI-specific activities and outcomes, including the number of HIV tests and the venues in which tests were conducted, basic demographic information about test recipients, the number of confirmed new and previously diagnosed HIV infections identified, and the proportions of persons with new HIV diagnoses successfully linked to medical care and referred to partner services.
During October 2007 - September 2010, a total of 2,786,739 HIV tests were conducted, of which 29,503 (1.1%) were positive for HIV infection. Among persons who were HIV-infected, 18,432 (62%) were unaware of their infection. Among 17,247 persons with new HIV diagnoses for whom some follow-up data were available, 15,737 (91%) received their test results, 12,711 (75%) were linked to care, and 14,234 (83%) were referred to partner services (Table 1). Compared with nonclinical settings, more persons who were tested in clinical settings received their test results (93% versus 84%) and were linked to care (78% versus 63%).
Men accounted for 55% of all tests and 72% of new HIV diagnoses; their test positivity rate was more than twice that among women (0.9% versus 0.4%) (Table 2). Non-Hispanic blacks, compared with non-Hispanic whites and Hispanics, accounted for approximately three times as many tests (60% versus 18% and 16% respectively) and approximately five times as many new HIV diagnoses (70% versus 14% and 12%, respectively). Similarly, the test positivity rate among blacks (0.8%) was 1.6 times that among whites (0.5%) and Hispanics (0.5%).
By the third year of the program, 1,331 venues were funded by health departments through ETI to conduct HIV testing. In total, 90% of tests were conducted in clinical settings, and 10% in nonclinical settings. Emergency departments (EDs), which accounted for 8% of the testing venues, performed 30% of all tests and identified 32% of all new HIV diagnoses (Table 3). Sexually transmitted disease (STD) clinics accounted for 21% of testing venues, 21% of all tests, and 20% of new HIV diagnoses. Substance abuse clinics, although accounting for 6% of all testing venues, accounted for 0.9% of tests and new HIV diagnoses. Community-based organizations (CBOs), which performed targeted testing based on risk and accounted for the majority of tests performed in nonclinical settings, accounted for a larger share of new diagnoses (11%) than tests performed (6%) or testing venues (7%). CBOs also produced the highest test positivity rate for new HIV diagnoses (1.2%), but the largest numbers of new diagnoses came from clinical settings, where lower test positivity rates (e.g., 0.8% for EDs and 0.6% for STD clinics) were offset by the larger numbers of persons screened.
Reported by: Abigail H. Viall, M.A., Samuel W. Dooley, M.D., Bernard M. Branson, M.D., Nadezhda Duffy, M.D., Jonathan Mermin, M.D., Janet C. Cleveland, M.S., Chris Cagle, Ph.D., Wendy A. Lyon, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Corresponding contributor: Abigail H. Viall, email@example.com, 404-639-2010.
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