Routine HIV testing making slow inroads

Guideline change still faces significant legal, financial and logistical hurdles.

By Victoria Stagg Elliott, AMNews staff. Oct. 8, 2007.

Susan Margletta, MD, a family physician in Norcross, Ga., a suburb of Atlanta, tests her patients for HIV if the slightest hint suggests that they could be carrying this virus. But does she offer to screen everyone ages 13 to 64 as recommended by Centers for Disease Control and Prevention guidelines? No. She is not convinced it is worth it.

"I'm not offering it to everyone who comes in the door. In 13 years of practice, I've diagnosed one person with HIV. How can I justify changing the way I practice? That's not logical or an appropriate use of resources," said Dr. Margletta, who is the board chair of the Georgia Academy of Family Physicians but was speaking personally.

A year after the CDC made a huge change to its HIV testing recommendations and called for the test to become a routine part of medical care available in a wide range of health care settings, many physicians are less than sold on the idea of offering it to all comers. Agency officials hope that removing the burden of risk assessment, along with the need for extensive counseling and explicit consent, will lead to screening and diagnosis of more of those who are infected but don't know it. An estimated 25% of those infected are unaware of their HIV status.

Data on the impact of this revision will not be available for another year, but early signs indicate that the reception has been mixed. The guidelines do allow physicians in areas with low rates of infection confirmed by routine testing to return to more traditional detection strategies, but CDC focus groups have found that many physicians are less than keen on attempting routine testing at all.