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A CUP OF HEALTH WITH CDC
HIV Testing: It Helps to Know
Routine Rapid HIV Testing in Emergency Departments
August 3, 2007

[Announcer] This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer,
healthier people.

[Matthew Reynolds] Welcome to A Cup of Health with CDC, a weekly broadcast of the
MMWR, the Morbidity and Mortality Weekly Report. I’m your host, Matthew Reynolds.

In the United States, approximately one million people are living with HIV. Of those,
nearly a quarter – that’s about 250,000 people - don’t know they are infected. When
people get tested for HIV and find out they are infected, they can benefit from earlier
access to live-saving treatment, and can take steps to reduce the risk of infecting their
partners. Dr. Jeff Schulden, a research physician with CDC’s HIV/AIDS prevention
program, is one of the authors of a recently published study that looked at the results of
routinely offering HIV testing to persons seeking care in hospital emergency
departments. He’s here to tell us more about the study’s findings. Welcome to the show,
Dr. Schulden.

[Dr. Schulden] Thanks for having me.

[Matthew Reynolds] Dr. Schulden, tell us more about this study and what you learned.

[Dr. Schulden] In these demonstration projects, we worked with three hospitals in New
York City, Los Angeles, and Oakland, California to offer HIV testing routinely to people
seeking care in their emergency departments. We showed that routinely providing HIV
testing in emergency departments is feasible and effective in helping people learn their
HIV status, especially those with limited access to health services. In these three
emergency departments, the majority of the more than 34,000 people offered HIV
testing agreed to be tested. Over 9,000 individuals received rapid HIV tests and of
those, approximately 1% were newly identified as HIV positive. All those newly
diagnosed with HIV were referred to care and at least 88 percent were actually linked to
medical follow up care.

[Matthew Reynolds] Why did you choose emergency departments for these projects?

[Dr. Schulden] Emergency departments are a vital link to populations at high risk for
HIV. They are often the first and only line of health care for many people with
undiagnosed HIV infection.

[Matthew Reynolds] What are the recommendations for offering an HIV test and how
is this different from past recommendations?

[Dr. Schulden] Last year, in 2006, CDC announced new HIV testing recommendations
for health care settings. The goal of these recommendations is to make HIV testing a
standard, routine part of medical care for all persons between the ages of 13 and 64,
and for all pregnant women, regardless of perceived risk of HIV. The previous HIV
testing recommendations for health care settings focused on those at perceived high
risk for HIV and those receiving care in high HIV prevalence areas. In practice, with the
old recommendations, patients were often visiting health care facilities without being
offered an HIV test. The new recommendations are much more straight forward, stating
that everyone between the ages of 13 and 64 should be tested, regardless of perceived
risk.

[Matthew Reynolds] I recall reading in the past that a person who got HIV testing
would have to go to the clinic get tested and then return to find out the results. Has that
changed?

[Dr. Schulden] It has. You’re right. With conventional HIV testing, it could sometimes
take anywhere from several days to up to two weeks for a person to receive their HIV
test results. Generally, a person would have to return to the facility were they had
received the test to get the results. In addition, with conventional HIV testing, generally,
they were performed using a blood sample which was taken with a needle. Now, with
rapid HIV testing, which were used in these projects, people can receive their HIV test
results in as little as 10 to 20 minutes, which means that in the same visit, in one visit
where a person receives the test, they actually also get the test result. With a person
not having to return to get the test results, it means that we as health care providers can
better ensure that people actually get their HIV test result. The other advantage to rapid
HIV testing is that they can be performed using finger prick blood or a oral swab of the
mouth, so they’re much easier to perform and they’re much more acceptable to people
who might not like needles.

[Matthew Reynolds] Given the relative ease of testing then that you just described,
why wouldn’t some people get tested for HIV?

[Dr. Schulden] Some of the reasons which people report for not getting HIV tested
include not having access to HIV testing services or not knowing where to get a test, not
having time for an HIV test, or thinking that they don’t need to get an HIV test. The new
recommendations will make HIV testing much more widely available across health care
settings and make it much more straight forward for people to receive an HIV test. We
also hope that by health care providers recommending that all people between the ages
of 13 and 64 receive an HIV test, it will further reduce the stigma and fear around HIV -
another commonly reported barrier to testing.

[Matthew Reynolds] Let’s say that people take this HIV test and find out that they are
infected. What actions would you hope they would take?

[Dr. Schulden] By diagnosing people earlier, we can link those who have HIV to care
and treatment earlier in the course of their infection. We now have excellent treatments
for people with HIV, allowing them to live long and healthy lives. The earlier people are
diagnosed with HIV and enrolled in care and treatment, the better their chances of
staying healthy longer. In addition, we know that individuals who are aware that they are
HIV infected are more likely to take steps to protect their partners from getting HIV. As
you mentioned earlier, it’s estimated that up to one quarter of the more than one million
people currently living with HIV in the U.S. are not aware of their HIV infection.

[Matthew Reynolds] Besides emergency departments, are there other places where
people can get an HIV test?

[Dr. Schulden] In terms of other clinical settings, we recommend that all health care
facilities offer HIV testing services to patients. This would not only include emergency
departments, but also primary care clinics, community clinics, in-patient facilities of
hospitals, and urgent care clinics. In addition to health care facilities, many communities
also have specific HIV voluntary testing and counseling centers where HIV testing is
available. These are often run by local HIV service organizations or community based
organizations.

[Matthew Reynolds] If HIV testing is done more often, do you think that that will have
an effect on people’s attitudes towards being tested?

[Dr. Schulden] Yes. By recommending HIV testing as a routine part of health care for
everyone between the ages of 13 and 64, we can help further reduce the stigma of this
disease. When health care providers offer this test to everyone, it acknowledges that
this is a disease which affects all communities and can affect all people. In addition,
CDC has more information about HIV, AIDS, and HIV testing on the CDC web site at
www.cdc.gov/hiv, and you can also learn more by calling the CDC information hotline
toll free at 1-800-CDC-INFO.

[Matthew Reynolds] Thank you for taking the time to talk with us today Dr. Schulden.

[Dr. Schulden] Thanks for having me.

[Matthew Reynolds] Well, that’s it for this week’s show. Don’t forget to join us next
week. Until then, be well. This is Matthew Reynolds for A Cup of Health with CDC.

[Announcer] To access the most accurate and relevant health information that affects you, your family
and your community, please visit www.cdc.gov.