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Targeted HIV Testing An Effective Way to Screen HIV Patients

According to an analysis by David Holtgrave, PhD, an expert on HIV prevention at the Johns Hopkins Bloomberg School of Public Health, a targeted campaign of testing and counseling aimed at those who are at high risk for HIV would be more effective than the mass patient screening proposed by the Centers for Disease Control and Prevention (CDC).

Holtgraves study is the first to examine the cost-effectiveness of the CDCs testing plan and is published in the June 2007 edition of the journal PLoS Medicine. The CDC estimates that 25 percent of Americans with HIV do not know they are HIV positive. Because they are unaware, they do not seek treatment and are at greater risk of spreading HIV to others.

To identify more Americans with HIV, the CDC has recommended that doctors in the United States test all patients aged 13 to 64 for HIV at every health care visit, unless the patient opts out, or specifically declines to be tested. In order to meet the demands of more testing, doctors can forgo the HIV risk reduction counseling that usually accompanies HIV testing.

'While the CDCs recommended opt-out testing offers some public health benefit, the data shows there would be substantially more benefit from a more targeted program that includes rather than discards risk reduction counselingincluding more diagnosed infections and more transmissions prevented,' said Holtgrave, who is professor and chair of the Bloomberg Schools Department of Health, Behavior and Society.

Using standard methods of cost-effectiveness analysis, Holtgrave estimates that CDCs recommended opt-out testing program would cost $864 million. For the same cost, a program of targeted counseling and testing would diagnose 188,170 new HIV infections, compared with 56,940 that would be detected through CDCs testing plan, assuming 1 percent of the population tested is HIV positive.

Additionally, targeted counseling and testing would prevent an estimated 14
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