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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Recommendations for HIV Testing Services for Inpatients and Outpatients in Acute-Care Hospital SettingsPlease note: An update has been published for this report. To view the update, please click here. Summary These recommendations update previous recommendations regarding human immunodeficiency virus (HIV) counseling and testing of patients in acute-care hospital settings (1). The revision was prompted by additional information regarding both the rates at which patients admitted to some acute-care hospitals have unrecognized HIV infection and the potential medical and public health benefits of recognizing HIV infection in persons who have not developed acquired immunodeficiency syndrome. BACKGROUND Since previous CDC recommendations regarding human immunodeficiency virus (HIV) counseling and testing of patients in acute-care hospitals were published in 1987, studies have described HIV seroprevalence rates ranging from 0.3% to 6.0% among various patient populations (2-7). In anonymous unlinked serologic surveys conducted by CDC, 0.2%-8.9% of persons receiving care in emergency departments and 0.1%-7.8% of persons admitted to acute-care hospitals were HIV antibody positive (8-10). In two studies in which data were obtained regarding previous HIV testing or diagnosis, 63% and 65% of the HIV seropositive patients were unaware of their HIV infection before hospital admission (2,5). In the period 1989-1990, CDC conducted anonymous unlinked serologic surveys to evaluate 13 hospital-specific variables as surrogate markers for hospital-specific HIV seroprevalence (11). The diagnosis rate for acquired immunodeficiency syndrome (AIDS) ({annual number of individual AIDS patients diagnosed and reported to the health department/annual number of discharges} x 1,000) was the only hospital-specific characteristic associated with hospital-specific seroprevalence. Based on the 1989-1990 surveys, an estimated 225,000 HIV-infected patients were cared for in the 5,558 acute-care U.S. hospitals in 1990; 163,000 of these HIV-infected patients were estimated to have a primary diagnosis other than HIV/AIDS. Of these 163,000 patients, 125,000 (77%) were admitted to the 593 (11%) hospitals with an AIDS diagnosis rate of greater than or equal to 1.0 per 1,000 discharges; 110,000 (88%) of the 125,000 patients were ages 15-54 years (Table 1). Thus, HIV testing of patients in this age range at these hospitals would potentially identify 68% of infected persons hospitalized in the United States for conditions other than HIV/AIDS. Knowledge of their HIV infection status allows infected persons and their infected partners to seek treatment with antiretroviral agents, prophylaxis against Pneumocystis carinii pneumonia, tuberculosis skin testing and tuberculosis prophylaxis (if appropriate), and other types of therapy and vaccines that may delay or prevent the opportunistic infections associated with HIV infection (12-15). Such measures have been shown to delay the onset of AIDS in infected persons and to prolong the lives of persons with AIDS (16,17). In addition, counseling and testing may help some persons change high-risk sexual and drug-use behaviors and thereby prevent HIV transmission to others (18-22). HIV counseling and testing programs are not a substitute for universal precautions or other infection-control techniques (23). Limited information does not support the belief that knowledge of a patient's HIV status decreases the risk of infection for health-care workers through closer adherence to universal precautions (24,25). HIV testing also must not be relied upon as a means of infection control in the hospital because a) test results may not be available in emergency settings, b) HIV tests will not detect a newly infected person who has not yet seroconverted, and c) other bloodborne pathogens (e.g., hepatitis B) may be present. RECOMMENDATIONS Voluntary and confidential HIV counseling and testing of patients in acute-care hospitals are useful for a) assisting in differential diagnosis of medical conditions, b) initiating early medical management of HIV infection, and c) informing infected persons or persons at risk for infection about behaviors that can prevent HIV transmission. To promote the appropriate use of HIV counseling and testing services, CDC recommends that acute-care facilities adopt the following guidelines *:
health-care providers to routinely ask patients about their risks for HIV infection and offer HIV counseling and voluntary testing services to patients at risk (1). Patients should give informed consent for testing in accordance with local laws.
regarding provision of routine HIV counseling and voluntary testing services. Other health-care institutions such as drug treatment centers, mental health facilities, and private medical practitioners are also encouraged to consider offering these services. The decision to offer these services routinely may be based on the HIV seroprevalence in the patient population. This rate may be determined most directly by a representative sample of unlinked anonymous specimens. ** Alternatively, hospitals and other health-care providers may elect to use an indirect marker of HIV seroprevalence, such as the AIDS diagnosis rate (defined above).
or an AIDS diagnosis rate greater than or equal to 1.0 per 1,000 discharges should strongly consider adopting a policy of offering HIV counseling and testing routinely to patients ages 15-54 years.
setting should be structured to facilitate confidential, voluntary patient participation and should include a) pretest information on the testing policies of the institution or physician and b) basic information about the medical implications of the test, the patient's option to receive more information, and the documentation of informed consent.
nonemergency settings in which patients are able to make an informed and voluntary decision regarding HIV testing. HIV counseling and testing for purposes other than immediate medical care should be deferred until a later time for persons who are too severely ill to understand the pretest information or give informed consent.
confidential manner and forwarded to state health departments in accordance with local law. Post-test counseling for infected patients and those at increased risk should be performed by trained health-care providers in accordance with existing CDC recommendations (1).
and are HIV antibody positive must not be denied needed medical care or provided suboptimal care. HIV-infected persons should receive medical evaluation for HIV infection and specific therapies and prevention services as needed. If therapeutic and prevention services are not available, the acute-care facility or provider should establish an effective referral system to ensure that these services will be provided.
necessary steps to protect the confidentiality of test results. The ability of facilities to assure confidentiality of patients' test information and the public's confidence in that ability are crucial to efforts to increase the number of persons being counseled and tested for HIV infection. Moreover, to assure broad participation in counseling and testing programs, the public must be assured that persons found to be HIV positive will not be subject to discrimination (1).
universal precautions and other infection-control techniques. THE ROLE OF HEALTH DEPARTMENTS State and local health departments are a source for at least three forms of assistance for implementing these recommendations. First, state and local health departments can provide data to assist hospitals to determine their AIDS diagnosis rate. Second, state and local health departments can provide technical assistance and training for hospital staff responsible for HIV-related counseling and testing services in acute-care settings. Third, health departments can help hospitals by providing partner notification services for HIV-infected patients, as well as additional prevention services for uninfected patients who are at high risk for HIV infection. Effective and ongoing collaboration between acute-care providers and health departments will improve both prevention and treatment services for persons infected with HIV or at risk for HIV infection. References
** To determine directly the rate of infection for a patient population, hospitals may consider conducting anonymous unlinked serologic surveys (i.e., testing of serum or plasma samples that were collected for other purposes and have had personal identifiers removed before testing). For guidelines regarding the conduct of blinded HIV serosurveys in hospitals, contact: Seroepidemiology Branch, Division of HIV/AIDS, Mailstop E-46, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, 30333. SUGGESTED CITATION: Centers for Disease Control and Prevention. Recommendations for HIV testing services and outpatients in acute-care hospital settings; and Technical guidance on HIV counseling. MMWR 1993;42(No. RR- 2):{inclusive page numbers}. CIO Responsible for this publication: National Center for Infectious Diseases Division of HIV/AIDS Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.Page converted: 09/19/98 |
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