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JAMA Study Released Today Supports Call for Routine HIV Testing in CA,




 

-- San Francisco Public Health Dept. Sees Major Increase in Rate of HIV Testing After Simplifying Screening Process in May 2006, According to JAMA Study

-- With an Estimated 40,000 HIV-Positive Californians Unaware of their Status, CA Routine Testing Bill (AB 682) Will Increase HIV Testing, Improve Health Outcomes & Reduce Transmission Rates

LOS ANGELES, March 14 /PRNewswire/ -- AIDS Healthcare Foundation (AHF) the nation's largest provider of HIV/AIDS healthcare, education and prevention and operator of free AIDS treatment clinics in the US, Africa, Asia and Latin America/Caribbean -- today urged legislators to support AB 682 (Berg, D-Eureka; Garcia, R-Cathedral City; Huffman, D-San Rafael), California's Routine HIV Screening Bill, citing a study published in the latest Journal of the American Medical Association (JAMA) "Association Between Rates of HIV Testing and Elimination of Written Consents in San Francisco," (March 14, 2007 -- Vol. 297, No. 10). The study examines the rate of HIV testing after the San Francisco Department of Public Health, in May 2006, replaced written consent with verbal consent for testing through its facilities. The results show a major increase in the rate of HIV testing after this move to streamline the testing process. For example, San Francisco General Hospital Medical Center went from diagnosing 20 cases of HIV a month to over 30.

The research letter, (authored by Jeff D. Klausner, MD, MPH and Mitchell H. Katz, MD of the San Francisco Department of Public Health (SFPHD), and Nicola M. Zetola, MD, Barbara Haller, MD, PhD and Patricia Nassos, PhD of the University of California, San Francisco) comes on the heels of recent recommendations issued by the Centers for Disease Control and Prevention (CDC) strongly urging routine HIV screening of all persons in a health care setting in order to increase the number of persons who know their status and can benefit from treatment, if necessary. In its most recent report, the CDC estimates that over 1 million Americans are living with HIV and at least one quarter do not know they are infected with HIV.

AB 682, sponsored by AIDS Healthcare Foundation and the California Medical Association (CMA), is designed to similarly remove statutory barriers so that medical providers can identify Californians who are unaware of their HIV status and bring them into care and treatment, while sustaining the fundamental voluntary nature of HIV screening. Current state law, enacted early in the epidemic, requires informed or written informed consent, depending on the setting, before an HIV test can be conducted. The current law makes it difficult for medical providers to screen routinely patients for HIV infection and contributes to the fact that nearly 40,000 Californians do not know that they are HIV positive and, hence, are not getting treatment and are unknowingly exposing others. AB 682 will change California law from informed consent to simple consent, with a requirement that a patient can decline the test.

"This change in law will trigger a cultural shift that will ensure that HIV screening becomes truly routine," said Whitney Engeran III, Director of Prevention and Testing for AIDS Healthcare Foundation. "Too many people are still learning of their HIV status when they present themselves to a healthcare provider due to an illness, often too late to fully benefit from treatment. The data from this latest San Francisco study illustrates the tremendous value of simplifying testing practices and the need for dramatic changes in law that will allow the rest of the state to mirror the success in San Francisco. Current law has outlived its usefulness when it is no longer a protection but an impediment to screening people who do not know that they are at risk of exposure. These Californians must get the information that will bring them into care and treatment and interrupt their unwitting exposure of others."

AHF noted that AB 682 goes a step further than San Francisco Public Health. SFPHD removed the requirement for a patient to sign a consent form, which removed a large barrier for patients to be comfortable with the test. The bill makes that same change but also removes the informed consent requirement, which has impeded medical providers from screening because of the legal burdens caused by a high standard like informed consent.

The research letter published today describes the results of an administrative change instituted by SFPHD: "Before May 2006, clinicians were required to complete a separate HIV test laboratory requisition form and obtain written documentation of patient informed consent to order an HIV test ... Beginning in mid-May 2006, patient consent forms were removed from medical settings and HIV antibody testing was added to the routine laboratory requisition form. Clinicians were required to document in the medical chart that patient consent was obtained (consistent with California state law), but a patient signature was not required."

The results show an increase in testing after the change in procedure: "The monthly rate of HIV testing increased steadily after the change in policy (from 13.5 HIV tests per 1000 patient-visits in June 2006 to 17.9 HIV tests per 1000 patient-visits in December 2006) ... At the end of the study period, mean monthly rate of HIV tests per 1000 patient-visits was 4.5 more than expected (95% confidence interval [CI]. 3.2-5.8; P<.001). The mean number of positive tests per month increased from 20.6 (95% CI, 17.3-23.8) before the change in policy to 30.6 (95% CI, 25.7-35.5) after the change in policy (P=.006)."

About AIDS Healthcare Foundation

AIDS Healthcare Foundation is the US' largest provider of HIV/AIDS healthcare, education and prevention and operator of free AIDS treatment clinics. The organization provides cutting-edge medical services and advocacy, regardless of ability to pay to more than 53,000 people in the United States, Asia, Latin America/Caribbean and Africa. AHF operates the largest free alternative HIV testing program in the state, providing more than 15,000 free HIV tests each year through its innovative testing program via testing sites at 5 AHF Out of the Closet thrift store locations throughout Southern California. In addition, AHF offers testing in the L.A. County Jail System and on a mobile testing van in greater Los Angeles.

SOURCE AIDS Healthcare Foundation



 


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Information in this article was accurate in March 14, 2007. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.