September 21, 2006 Dear Colleague: Please find attached two documents of interest: CDC's Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings (MMWR 2006; 55 (No. RR-14): 1-18) and a CDC HIV/AIDS Science Fact Sheet (September 2006) summarizing the changes in the new recommendations.
As you will see when you review the attachments, the CDC is now recommending that screening for HIV infection be performed routinely in all health care settings for all patients aged 13-64 years. CDC's rationale for this change is to encourage early diagnosis of HIV infection so as to optimize both medical and prevention outcomes for the estimated 250,000 persons in the US who are infected with HIV and unaware of their diagnoses. The new CDC guidelines also recommend that consent for HIV screening in health care settings be incorporated into the general consent for medical care; separate written consent is no longer recommended. However, the CDC document is very clear that "screening should be voluntary and undertaken only with the patient's knowledge and understanding that HIV testing is planned."
Several studies (see Under Secretary for Health's 9/2/2005 Information Letter) indicate that late diagnosis of HIV infection is also a significant problem among many veterans receiving care in the VA. As such, we support the importance of offering every veteran under VA care the opportunity to have a voluntary HIV test and will continue to promote efforts to reduce barriers to diagnosing HIV in a timely manner.
However, it is essential that all VA providers be reminded that current federal law (Section 124 of Public Law 100-322) requires separate written consent and pre-and post-test counseling of veterans being tested for HIV in VA facilities. As such, the new CDC recommendations do not supersede current VA regulations.
Senior staff in the Public Health Strategic Health Care Group look forward to partnering with you in the coming months to identify ways in which we can improve HIV care for infected veterans--especially by promoting the early diagnosis of HIV infection. Should you have additional questions about current VA HIV testing policies or practices, please contact Ms. Jane Burgess, 202-273-8532, jane.burgess@va.gov or Dr. Kim Hamlett-Berry, 202-273-8929, kim.hamlett@va.gov or visit VHA's HIV website.
Thank you for your time and attention.
Sincerely,
Ronald O. Valdiserri, M.D., M.P.H.
Chief Consultant, Public Health Strategic Health Care Group
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