A Robust Case for Screening for HIV

Routine rapid testing for HIV infections in primary care practices can lead to an increased diagnosis and earlier detection of HIV infected individuals, according to a new study.

"These findings provide, to our knowledge, the first robust evidence from a randomized study that a screening program leads to increased rate of HIV diagnosis," write the authors of the study, published in the June 2015 The Lancet HIV.

Many people infected with HIV go undiagnosed. “Early diagnosis saves lives and reduces onward transmission,” the authors write.

They assessed whether an education program promoting rapid HIV testing among general practitioners would lead to increased and earlier HIV diagnosis in a cluster, randomized controlled trial.

The study, led by Dr Werner Leber of the Centre for Primary Care and Public Health, Queen Mary University of London, included 40 general practices in London. They assigned 20 practices to the intervention, which included staff training and routine opt-out rapid HIV testing at intake to newly registered adult patients. The other 20 practices continued with usual care.

A total of 46 new diagnoses were made during the study period-- 32 among the nearly 45,000 newly registered patients in the intervention practices and 14 among the more than 38,000 newly registered patients in the control practices. The overall rate of HIV diagnosis was more than 4 times higher in the intervention group (0.30 per 10,000 patients per year) than in the control group (0.07 per 10,000 patients per year).

"Our study did not show significant differences between groups in CD4 counts at diagnosis, although diagnosis seemed to be non-significantly earlier in the intervention clinics," the authors write.

Mean CD4 counts at diagnosis was 356 cells/μL in the intervention practices as compared to 270 cells/μL in the control practices. Slightly more than half of patients in intervention practices vs slightly more than one-third in control practices had CD4 counts less than 350 cells per μL. About one-quarter of the intervention practice patients vs about one-half of the control practice patients had CD4 counts less than 200 cells per μL.

All patients diagnosed by rapid testing were successfully transferred into specialist care. No adverse events occurred.

The authors concluded that “we therefore recommend implementation of HIV screening in general practices in areas with high HIV prevalence.”

The authors of an accompanying editorial note that “the continuing HIV epidemic is fuelled by the large number of people who are unaware of their HIV status.” In the US, the 18% of people who are unaware of their HIV status accounted for 30% of all new infections each year.

“Additionally, population-based HIV prevention strategies-- such as test and treat and treatment as prevention -- rely on HIV testing, further establishing HIV testing as a cornerstone of HIV prevention. In the UK and USA, routine HIV testing in health-care settings is recommended to identify individuals who are unaware of being infected with HIV and to reduce missed opportunities for diagnosis,” they write.