{"id":536,"date":"2011-11-28T14:03:11","date_gmt":"2011-11-28T14:03:11","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=536"},"modified":"2011-11-28T14:07:42","modified_gmt":"2011-11-28T14:07:42","slug":"non-targeted-hiv-testing-in-health-settings-worthwhile","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/","title":{"rendered":"Non-targeted HIV testing in health settings – worthwhile?"},"content":{"rendered":"

A large, recently published French study, based in metropolitan Paris, places a question mark over the value of non-targeted HIV screening as a strategy to lower the number of undiagnosed infections and improve early detection.<\/p>\n

Late diagnosis of HIV remains a common problem both in France \u2013 where, despite accessible testing, one-third of diagnoses are in conjunction with CD4 counts less than 200\/\u03bcL \u2013 and in other countries. \u00a0National health authorities have therefore promoted untargeted testing in the US, the UK and France.\u00a0\u00a0\u00a0 However, the strategy remains controversial.\u00a0 The authors of this study claim that it is the first large-scale study to have assessed its effectiveness.<\/p>\n

The testing was conducted in 29 Paris Emergency Departments (ED) \u2013 an ideal setting for assessing the impact of untargeted testing, given that 25% of French population visit an ED at least once a year, including low-income, uninsured and other subgroups that might not be reached in other health care settings.\u00a0 Of the 20,962 eligible patients who visited the EDs during the periods when screening was operative (i.e. during the 6-week period randomly assigned to each participant ED), a total of 12,754, or 63% of those eligible, consented to the test.<\/p>\n

The number of HIV cases newly diagnosed (18 or 0.14%) as a result of the study, though small, fell within the authors\u2019 expectations.\u00a0 The significant finding relates to the characteristics of those newly diagnosed.\u00a0 With one exception, they all belonged to high risk groups \u2013 sub-Saharan African or men having sex with men (MSM). \u00a08 were being seen for HIV related symptoms, 7 of them with advanced-stage disease.\u00a0 Of the 18 newly diagnosed, 6 did not return for a follow-up visit despite repeated calls, 4 were hospitalized immediately, 8 returned for the follow-up.\u00a0 Among the 12 patients successfully linked to care, only 4 had CD4 counts greater than 350\u03bc\/L.<\/p>\n

Certainly, this intervention does not appear to have reached infected persons not belonging to high-risk groups.\u00a0 The authors point out that an ED-based screening strategy limited to men aged 18-45 and African-born persons would have identified all new HIV infections for 50% fewer HIV tests!\u00a0\u00a0 Questionnaires administered to consenting patients demonstrate characteristics that seem broadly representative of the Paris population, and findings of a complementary study of covariates of HIV refusal in 7 EDs suggest that refusal-associated factors did not unduly bias the results of the study.\u00a0 The authors conclude that their observations do not<\/em> support the implementation of non-targeted screening in the ED setting.\u00a0 Given this study group appears highly representative of the general population, the authors are also very sceptical of the likely value of untargeted screening in other healthcare settings \u2013 at least in France.<\/p>\n

The applicability of these findings to other countries cannot be assumed.\u00a0 But the study certainly highlights the need for additional country-specific studies of the effectiveness of the strategy of untargeted HIV testing.<\/p>\n

Kayigan Wilson d\u2019Almeida, Anne-Claude Cr\u00e9mieux et al., \u201cModest Public Health Impact of Nontargeted Human Immunodeficiency Virus Screening in 29 Emergency Departments\u201d, Archives of Internal Medicine<\/em>, published online 24th<\/sup> October 2011<\/p>\n

http:\/\/archinte.ama-assn.org\/cgi\/content\/full\/archinternmed.2011.535<\/a><\/p>\n

For national strategies supportive of untargeted HIV testing, see the following:<\/p>\n

In the US: \u00a0http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/rr5514a1.htm<\/a>;\u00a0 in the UK http:\/\/www.hpa.org.uk\/Publications\/InfectiousDiseases\/HIVAndSTIs\/1011TimetotestHIVtesting\/<\/a>; in France http:\/\/www.sante.gouv.fr\/plan-national-de-lutte-contre-le-vih-sida-et-les-ist-2010-2014.html<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

A large, recently published French study, based in metropolitan Paris, places a question mark over the value of non-targeted HIV screening as a strategy to lower the number of undiagnosed infections and improve early detection. Late diagnosis of HIV remains a common problem both in France \u2013 where, despite accessible testing, one-third of diagnoses are […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[264,2274,1642],"tags":[4372],"class_list":["post-536","post","type-post","status-publish","format-standard","hentry","category-health-policy","category-hiv-epidemiology","category-hiv-testing","tag-health-policy"],"yoast_head":"\nNon-targeted HIV testing in health settings - worthwhile? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Non-targeted HIV testing in health settings - worthwhile? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"A large, recently published French study, based in metropolitan Paris, places a question mark over the value of non-targeted HIV screening as a strategy to lower the number of undiagnosed infections and improve early detection. Late diagnosis of HIV remains a common problem both in France \u2013 where, despite accessible testing, one-third of diagnoses are [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2011-11-28T14:03:11+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2011-11-28T14:07:42+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2011\\\/11\\\/28\\\/non-targeted-hiv-testing-in-health-settings-worthwhile\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2011\\\/11\\\/28\\\/non-targeted-hiv-testing-in-health-settings-worthwhile\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Non-targeted HIV testing in health settings – worthwhile?\",\"datePublished\":\"2011-11-28T14:03:11+00:00\",\"dateModified\":\"2011-11-28T14:07:42+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2011\\\/11\\\/28\\\/non-targeted-hiv-testing-in-health-settings-worthwhile\\\/\"},\"wordCount\":547,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"keywords\":[\"health policy\"],\"articleSection\":[\"health policy\",\"HIV Epidemiology\",\"HIV testing\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2011\\\/11\\\/28\\\/non-targeted-hiv-testing-in-health-settings-worthwhile\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2011\\\/11\\\/28\\\/non-targeted-hiv-testing-in-health-settings-worthwhile\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2011\\\/11\\\/28\\\/non-targeted-hiv-testing-in-health-settings-worthwhile\\\/\",\"name\":\"Non-targeted HIV testing in health settings - worthwhile? - Sexually Transmitted Infections\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#website\"},\"datePublished\":\"2011-11-28T14:03:11+00:00\",\"dateModified\":\"2011-11-28T14:07:42+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2011\\\/11\\\/28\\\/non-targeted-hiv-testing-in-health-settings-worthwhile\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2011\\\/11\\\/28\\\/non-targeted-hiv-testing-in-health-settings-worthwhile\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2011\\\/11\\\/28\\\/non-targeted-hiv-testing-in-health-settings-worthwhile\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Non-targeted HIV testing in health settings – worthwhile?\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\",\"name\":\"Sexually Transmitted Infections\",\"description\":\"Discussion and suggestion space for readers of STIs\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\",\"name\":\"Sexually Transmitted Infections\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/files\\\/2017\\\/10\\\/blog-logo-sti.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/files\\\/2017\\\/10\\\/blog-logo-sti.png\",\"width\":378,\"height\":34,\"caption\":\"Sexually Transmitted Infections\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/author\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Non-targeted HIV testing in health settings - worthwhile? - Sexually Transmitted Infections","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/","og_locale":"en_US","og_type":"article","og_title":"Non-targeted HIV testing in health settings - worthwhile? - Sexually Transmitted Infections","og_description":"A large, recently published French study, based in metropolitan Paris, places a question mark over the value of non-targeted HIV screening as a strategy to lower the number of undiagnosed infections and improve early detection. Late diagnosis of HIV remains a common problem both in France \u2013 where, despite accessible testing, one-third of diagnoses are [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/","og_site_name":"Sexually Transmitted Infections","article_published_time":"2011-11-28T14:03:11+00:00","article_modified_time":"2011-11-28T14:07:42+00:00","twitter_card":"summary_large_image","twitter_misc":{"Written by":"","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/"},"author":{"name":"","@id":""},"headline":"Non-targeted HIV testing in health settings – worthwhile?","datePublished":"2011-11-28T14:03:11+00:00","dateModified":"2011-11-28T14:07:42+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/"},"wordCount":547,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/sti\/#organization"},"keywords":["health policy"],"articleSection":["health policy","HIV Epidemiology","HIV testing"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/","url":"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/","name":"Non-targeted HIV testing in health settings - worthwhile? - Sexually Transmitted Infections","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/sti\/#website"},"datePublished":"2011-11-28T14:03:11+00:00","dateModified":"2011-11-28T14:07:42+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/sti\/"},{"@type":"ListItem","position":2,"name":"Non-targeted HIV testing in health settings – worthwhile?"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/sti\/#website","url":"https:\/\/blogs.bmj.com\/sti\/","name":"Sexually Transmitted Infections","description":"Discussion and suggestion space for readers of STIs","publisher":{"@id":"https:\/\/blogs.bmj.com\/sti\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/sti\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/sti\/#organization","name":"Sexually Transmitted Infections","url":"https:\/\/blogs.bmj.com\/sti\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/sti\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/sti\/files\/2017\/10\/blog-logo-sti.png","contentUrl":"https:\/\/blogs.bmj.com\/sti\/files\/2017\/10\/blog-logo-sti.png","width":378,"height":34,"caption":"Sexually Transmitted Infections"},"image":{"@id":"https:\/\/blogs.bmj.com\/sti\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"","url":"https:\/\/blogs.bmj.com\/sti\/author\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts\/536","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/users\/152"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/comments?post=536"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts\/536\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/media?parent=536"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/categories?post=536"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/tags?post=536"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}