Recommendations for Human Immunodeficiency
Virus (HIV) Screening in Tuberculosis (TB) Clinics
Updated: April 2008
What are the recommendations for human immunodeficiency virus
(HIV) screening in tuberculosis (TB) clinics?
revised recommendations from 2006, CDC recommends HIV screening
for all TB patients after the patient is notified that testing will
be performed, unless the patient declines (i.e., opt-out screening).
Routine HIV testing is also recommended for persons suspected of
having TB disease and contacts to TB patients. Persons at high risk
for HIV infection should be screened for HIV at least annually.
Prevention counseling and separate written consent for HIV testing
should no longer be required.
How do the new 2006 recommendations for HIV screening differ
from previous ones?
These recommendations only address health care settings and do
not replace previous recommendations for HIV testing in
non-clinical, outreach, or field settings. The recommendations are
aimed to eliminate missed opportunities for HIV screening and reduce
significant barriers to HIV testing in health care settings by
- Using opt-out HIV screening;
- Annually screening persons at high risk for HIV;
- Eliminating the need for separate written consent for HIV
- Eliminating the need for prevention counseling as part of
routine HIV screening.
What is opt-out screening?
Opt-out screening is defined as performing HIV testing after
notifying the patient that the test will be performed, and although
the patient may decline or defer testing, it is strongly
recommended. Assent is inferred unless the patient declines testing.
Why does CDC recommend that TB clinics screen their patients for
HIV infection is the most important known risk factor for
progression from latent TB infection to TB disease. Progression to
TB disease is often rapid among HIV-infected persons and can be
deadly. In addition, TB outbreaks can rapidly expand in HIV-infected
Targeted HIV testing based on provider assessment of patient risk
behaviors fails to identify a substantial number of persons who are
HIV infected. This is because many individuals may not perceive
themselves to be at risk for HIV or do not disclose their risks.
Routine HIV testing also reduces the stigma associated with testing.
When HIV is diagnosed early, appropriately timed interventions can
lead to improved health outcomes, including slower progression and
reduced mortality. Identifying TB patients, suspects, and contacts
who are HIV infected allows for optimal TB testing of these groups
and provides opportunities to prevent TB in those without disease.
Who should be tested for HIV in TB clinics?
All patients in TB clinics should be tested for HIV. This
includes TB suspects, patients, and contacts.
Can rapid HIV tests be used to screen TB patients and their
Rapid HIV tests, using fingerprick or oral specimens, can be
used. Results are available in about 20 minutes. Although the rapid
HIV test kits cost about $10 more per test than standard lab assays,
they have been shown to be cost-effective and to increase patients’
acceptance of HIV testing. Another option is to collect oral swab
specimens and use standard lab assays.
What education and training resources on HIV counseling and
testing are available?
Resources for education and training on HIV counseling and
testing are available from CDC-funded HIV/AIDS programs in each
state health department, and from the
National Network of
STD/HIV Prevention Training Centers. Additionally, the Health
Resources and Services Administration (HRSA) has regional AIDS Education and Training Centers
(AETCs) and other local performance sites that can provide training
in HIV counseling and testing to TB staff.
Also available is a
Contact Investigation and Management Protocol to facilitate HIV
counseling, testing, and referral during TB contact investigations.
The protocol was developed by the New York City Bureau of TB
Control, in collaboration with the New York City Department of
Health HIV Training Institute, with funding from CDC.
Last Modified: 04/30/2008
Last Reviewed: 05/18/2008
Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention