Achieving universal HIV screening: Following CDC recommendations in states with incompatible laws

Issues: In September 2006, the CDC released guidelines recommending universal opt-out HIV screening, including elimination of written consent and pre-test counseling, throughout the health care system for every person aged 13-64. However, 22 states have legal statutes that restrict enactment of these recommendations. Pennsylvania, the seventh highest state in number of cumulative AIDS cases, requires written consent and pre-test counseling before HIV testing.

Description: In Philadelphia, a university-based HIV clinic managing rapid HIV testing programs in a hospital-wide medical system attempted to incorporate the CDC's recommendations into their testing programs. Aims were to increase testing rates, recognize undiagnosed HIV infection, and decrease the stigma of testing. Program managers worked closely with the local health department, legal community, and legislators to ensure state regulations were followed while streamlining HIV testing and eliminating barriers to routine testing.

Lessons Learned: Implementation plans were created that followed state laws, while allowing more streamlined and routinized HIV testing. Barriers to informed and voluntary HIV testing were reduced. Strategies included incorporating written HIV consent into universal medical consent for care, promotion of universal HIV testing throughout hospital system, and inclusion of educational materials to supplement pre-test counseling requirements.

Recommendations: Work closely with city legislative and public health officials. Form alliances with HIV experts in the local legal community. Achieve buy-in from hospital administrators and staff. Educate staff about benefits of HIV detection and their key role in achieving patient acceptability of testing. Form linkages between HIV care practices and medical venues to achieve care linkage.