Public Health

When it comes to screening for HIV, STIs, what’s routine?

Jennifer Lubell , Contributing News Writer

What's the news: The AMA has released a new toolkit to help physicians and other health professionals increase routine screenings for HIV, sexually transmitted infections (STIs), viral hepatitis and latent tuberculosis infections (LTBIs). 

Supported by the Centers for Disease Control and Prevention (CDC), the toolkit builds on the AMA’s work to understand key barriers and drivers for implementing routine screening in health care. The toolkit’s evidence-based approach shares actionable steps for routine screening programs, specific to community health centers and emergency departments. 

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Physicians and others in community health centers and emergency departments vetted the free toolkit. Reviewers included practice leaders and champions looking to optimize routine screening practices. In 2022, the AMA worked with community health center sites to test the best-practice strategies in the toolkit. With feedback from the community health center pilot sites incorporated into the toolkit, the AMA in late 2023 launched a similar pilot with emergency department sites.

The toolkit resources include a mix of both implementation and training-related materials, including optimal workflows and screening algorithms. Users can review the toolkit, which is organized along the screening and testing continuum, from end-to-end or focus on a specific stage of screening depending on the needs of their organization. 

Some of the screening strategies outlined in the toolkit include best practices and resources for implementing an opt-out approach to screening, sticking to sex-positive, status-neutral messaging and streamlining the testing cascade. 

Why it's important: Millions of Americans are diagnosed with HIV, STIs, viral hepatitis or TB each year. Tens of thousands die from their infection. In 2011–2012, an estimated 13 million people had latent TB. In 2021, 1.2 million had HIV, and there were 2.5 million cases of gonorrhea, syphilis and chlamydia. Such infections often share modes of transmission and demographics that increase risk of infection. 

Screening programs driven by guidelines can identify infection, creating opportunities for treatment and prevention. Routine screening and early detection of HIV, STIs, viral hepatitis and LTBI can help communities identify infections at the asymptomatic stage. 

“With patient access to preventive services interrupted during the COVID-19 pandemic, many individuals may not even be aware they have an infection and are at risk of contributing to new infections,” said AMA President Jesse M. Ehrenfeld, MD, MPH. “Social inequities and stigma also continue to be barriers to screening. We are grateful to the pilot sites and subject-matter experts who contributed to this resource to help improve routine screening.”

Learn more: Dr. Ehrenfeld took part in the first of a planned series of three AMA Ed Hub™ webinars to address the importance of routine screening for HIV, STIs, viral hepatitis and LTBI, discuss the new toolkit in greater depth.

He was joined by Jonathan Mermin, MD, MPH, director of CDC's National Center for HIV, Viral Hepatitis, STD, and TB Prevention and a retired two-star rear admiral in the U.S. Public Health Service. They explained how the new toolkit supports community health centers and emergency departments in two focus areas: implementing opt-out screening and empowering every member of the care team with education. 

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