2011 National HIV Prevention Conference-Plenaries-Tuesday.

1. Universal Testing
Testing our Way out of the
HIV/AIDS Epidemic
• Testing our Way out of the
HIV/AIDS Epidemic
Polly E. Ross, MD
WNC Community Health Services
Asheville, N.C.

2. Can we test our way out of the
HIV/AIDS Epidemic in the U.S.?
Doubtful…..

3. Are We Testing?

4. Testing… YES
BUT we are testing the wrong
people….
Not Testing – Minorities!!

11. Testing… YES
BUT we are testing the wrong
people….
Not Testing – Men who have sex
with Men.

13. Current Testing Strategies
Test at CHC --- Testing those engaged in
care.
Testing at Night clubs/Gay bars ---
Testing self-selected well.

14. Current Testing Strategies –
Not Working!!!
Points of Care testing – poorly funded
…And not effective!

15. MMWR: Results of Expanded HIV Testing
Initiative25 Jurisdictions, – United States,
2007 -2010 June 24, 2011 /60(24); 805-810.
2,786,739 tests in the 3 yrs;
29, 503 HIV + persons identified;
18,432 HIV + NEW infections;
Tested 11,071 persons
who already had been tested BEFORE!

16. MMWR: Results of Expanded HIV Testing
Initiative 25 Jurisdictions, – United States,
2007 -2010 June 24, 2011 /60(24); 805-810.
18,432 HIV + NEW infections;
15,737 HIV + newly identified received
their results. = 2,695 NO Results
12,711 HIV+ newly identified linked to
care. = 5,721 NOT in Care
Clinical Settings ( CHC and ER) had a higher
rate of providing test results and linkage to care.

17. MMWR: Results of Expanded HIV Testing
Initiative 25 Jurisdictions, – United States,
2007 -2010 June 24, 2011 /60(24); 805-810.
$111 million dollars = 15,478 New HIV+
$7,171 dollars per new person identified
240,000 unidentified persons x $7,171/test
= $1,721,152,603 dollars
2,757,236 Negative tests!

18. Routine Opt-Out Rapid HIV Screening and
Detection of HIV Infection in Emergency
Department Patients. –JAMA.2010;304(3):
284-292. Haukoos, Jason et al.
At DHMC-477 bed urban, safety net
hospital who serves mostly minorities.
Three separate four month non-targeted
HIV screening episodes as well as
diagnostic testing.

19. 25%
0.018%
Haukoos, J. S. et al. JAMA 2010;304:284-292 10 new Infections-0.001%

20. MMWR:HIV Screening of Male Inmates
During Prison Intake Medical
Evaluation, Washington,2006-1010
• Three methods of testing – Washington
State Dept. of Corrections.
• Request or Clinical indication
• Opt-In
• Opt-Out
MMWR/June 24,2011/
Vol.60/No.24 p.811

21. MMWR:HIV Screening of Male Inmates
During Prison Intake Medical
Evaluation, Washington,2006-1010
Request or Clinical indication (19 months)– 610
tested – 5 HIV+ (0.5%)
Opt-In – (30.5 months) – 12,173 tested –13 HIV+
( 0.11%)
Opt-Out – (7.5 months) – 4,651 tested – 6 HIV+
( 0.13%)
MMWR/June 24,2011/
Vol.60/No.24 p.811

22. Summary: aka – THE FACTS
New HIV infections in the US –
unchanged!
New 2006 CDC HIV Screening
Guidelines –
Costly!
not effective!

23. Can we test our way out of the
HIV/AIDS Epidemic in the U.S.?
Doubtful…..