HIV SCREENING AND ACCESS TO CARE

Exploring Barriers and Facilitators to Expanded HIV Testing

Committee on HIV Screening and Access to Care

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, DC.
www.nap.edu



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R1
HIV SCREENING A ND A CCESS T O C ARE Exploring Barriers and Facilitators t o E x p a n d e d H I V Te s t i n g Committee on HIV Screening and Access to Care Board on Population Health and Public Health Practice

OCR for page R1
THE NATIONAL ACADEMIES PRESS ∙ 500 Fifth Street, N.W. ∙ Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This study was supported by Contract No. HHSP23320042509XI between the National Academy of Sciences and the White House Office of National AIDS Policy. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-15661-5 International Standard Book Number-10: 0-309-15661-0 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap. edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2010 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2010. HIV screening and access to care: Exploring barriers and facilitators to expanded HIV testing. Washington, DC: The National Academies Press.

OCR for page R1
“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

OCR for page R1
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

OCR for page R1
COMMITTEE ON HIV SCREENING AND ACCESS TO CARE PAUL D. CLEARY (Chair), Dean, Yale School of Public Health, New Haven RONALD BAYER, Professor, Department of Sociomedical Sciences, Joseph L. Mailman School of Public Health, Columbia University, New York ERIC G. BING, Endowed Professor of Global Health and HIV, Charles R. Drew University of Medicine and Science, Los Angeles SCOTT BURRIS, Professor, School of Law, Temple University, Philadelphia J. KEVIN CARMICHAEL, Chief of Service, Special Immunology Associates, El Rio Community Health Center, Tucson SUSAN CU-UVIN, Professor of Obstetrics and Gynecology and Medicine, Brown University, Providence JENNIFER KATES, Director, Global Health Policy and HIV, The Henry J. Kaiser Family Foundation, Washington, DC ARLEEN A. LEIBOWITZ, Professor, School of Public Affairs, University of California, Los Angeles ALVARO MUñOZ, Professor, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore LIISA M. RANDALL, Manager, HIV Prevention Programs, Michigan Department of Community Health, Lansing BETH SCALCO, Chief of Staff, Louisiana Office of Public Health, New Orleans VICTOR J. SCHOENBACH, Associate Professor, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill MARTIN F. SHAPIRO, Professor, Departments of Medicine and Health Services, University of California, Los Angeles LIZA SOLOMON, Principal Associate, Domestic Health Division, Abt Associates, Bethesda ANTONIA M. VILLARRUEL, Associate Dean for Research, School of Nursing, University of Michigan, Ann Arbor Project Staff MORGAN A. FORD, Study Director RITA DENG, Associate Program Officer (April 2010–August 2010) NORA HENNESSY, Associate Program Officer (October 2009–April 2010) KAREN ANDERSON, Senior Program Officer CHINA DICKERSON, Senior Program Assistant MARIA HEWITT, Rapporteur ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice MARK GOODIN, Editor 

OCR for page R1

OCR for page R1
Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Adaora Adimora, School of Medicine, University of North Carolina, Chapel Hill George Ayala, Global Forum on MSM and HIV Thomas J. Coates, School of Medicine, University of California, Los Angeles James G. Hodge, Jr., Sandra Day O’Connor College of Law, Arizona State University William L. Holzemer, College of Nursing, Rutgers, The State University of New Jersey Bruce Jennings, Center for Humans and Nature Roger J. Lewis, School of Medicine, University of California, Los Angeles David J. Malebranche, School of Medicine, Emory University Celia J. Maxwell, Howard University Hospital ii

OCR for page R1
iii REVIEWERS Randall Mayer, Iowa Department of Public Health Stephen Raffanti, Vanderbilt University Medical Center Ann Robbins, Texas Department of State Health Services Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Kristine M. Gebbie, School of Nursing, Hunter College of the City University of New York. Appointed by the National Research Council, she was responsible for mak- ing certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

OCR for page R1
Contents ABBREVIATIONS AND ACRONYMS xiii ABSTRACT xv HIV SCREENING AND ACCESS TO CARE: EXPLORING BARRIERS AND FACILITATIORS TO EXPANDED HIV TESTING 1 Background, 4 CDC Revised HIV Testing Guidelines, 8 Public Workshop and Literature Review, 10 Laws, Health Coverage Policies, and Other Policies That Impede HIV Testing, 10 Methods and Policies to Increase HIV Testing and Identification of HIV Positive Individuals, 30 Impact of Opt-Out HIV Testing, 41 Closing Remarks, 45 REFERENCES 47 APPENDIXES A Biographical Sketches of Committee Members 57 B Biographical Sketches of Workshop Speakers 65 C Workshop Agenda 75 D Workshop Attendees 79 ix

OCR for page R1

OCR for page R1
Tables, Figures, and Boxes TABLES 1 Estimated Number and Percent of Undiagnosed HIV Cases, by Race/Ethnicity and Transmission Category, 5 2 Select State HIV Testing Laws, 12 FIGURES 1 Percentage of people who reported being tested for HIV in past 12 months, by year, 7 2 Number of states implementing components of the CDC’s 2006 revised HIV testing recommendations, 13 3 Municipal HIV/AIDS test scale up campaigns, 35 4 ACTS pocket guide, 37 5 Implementation of opt-out testing in health care settings by 65 state, territorial, and local health departments after the Expanded Testing Initiative (as of February 2008), 43 BOXES 1 Statement of Task, 2 2 Key Definitions, 9 xi

OCR for page R1

OCR for page R1
Abbreviations and Acronyms ADA Americans with Disabilities Act ADAP AIDS Drug Assistance Program AIDS acquired immune deficiency syndrome ART antiretroviral therapy CBO community-based organization CDC Centers for Disease Control and Prevention CHC community health clinics CLIA Clinical Laboratory Improvement Amendments CMS Centers for Medicare & Medicaid Services ED emergency department EOB explanation of benefits ETI Expanded Testing Initiative H1N1 Subtype of Influenza A in the 2009 pandemic HAART highly active antiretroviral therapy HEDIS Healthcare Effectiveness Data and Information Set HIPAA Health Insurance Portability and Accountability Act HIV human immunodeficiency virus HMO Health Maintenance Organization IDU injection drug user xiii

OCR for page R1
xi ABBREVIATIONS AND ACRONYMS IHS Indian Health Service IOM Institute of Medicine KFF Kaiser Family Foundation MSM men who have sex with men NASTAD National Alliance of State and Territorial AIDS Directors NHAS National HIV/AIDS Strategy ONAP White House Office of National AIDS Policy PJP Pneumocystis jiroecii pneumonia RNA ribonucleic acid STD sexually transmitted disease TB tuberculosis USPSTF U.S. Preventive Services Task Force

OCR for page R1
Abstract The HIV epidemic remains a major disease burden in the United States, with approximately 56,300 new infections occurring each year (CDC, 2008a). Knowledge of HIV status and receipt of timely care can help to prevent HIV transmission and improve clinical outcomes. Yet, of the 1.1 million people in the United States living with HIV/AIDS, approximately 21 percent are unaware that they are infected with the disease (Campsmith et al., 2010). The White House Office of National AIDS Policy (ONAP) has developed a National HIV/AIDS Strategy (NHAS) to reduce new HIV infec- tions, increase access to care and improve health outcomes for individuals living with HIV, and reduce HIV-related health disparities in the United States (ONAP, 2010b). To help inform the implementation of the NHAS, an Institute of Medicine committee hosted a public workshop and gathered data to assess the extent to which federal and state laws and policies and private health insurance policies pose a barrier to expanded HIV testing. The committee identified barriers to HIV testing that included state legal requirements for HIV testing; discordant federal HIV testing recommenda- tions; public and private health insurance policies; policies inhibiting use of rapid HIV tests; and policies and practices in corrections settings. In addi- tion, the committee identified the need for more programs and policies to promote clinician education and training and reduce constraints on practice environments, as well as reduce HIV stigma and discrimination, as barri- ers to expanded HIV testing. The committee identified several strategies to increase HIV testing and identification of HIV-infected individuals as well. x

OCR for page R1
xi ABSTRACT The research reviewed by the committee indicates that opt-out HIV testing, where an individual is told that testing will be performed unless he or she declines, may facilitate HIV testing, although there is still debate about the ethics of opt-out HIV testing.