Hepatitis: Branson BM

Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE, Anonymous00353. · Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (proposed), Atlanta, GA 30333, USA. · MMWR Recomm Rep. · Pubmed #16988643 links to  free full text

Abstract: These recommendations for human immunodeficiency virus (HIV) testing are intended for all health-care providers in the public and private sectors, including those working in hospital emergency departments, urgent care clinics, inpatient services, substance abuse treatment clinics, public health clinics, community clinics, correctional health-care facilities, and primary care settings. The recommendations address HIV testing in health-care settings only. They do not modify existing guidelines concerning HIV counseling, testing, and referral for persons at high risk for HIV who seek or receive HIV testing in nonclinical settings (e.g., community-based organizations, outreach settings, or mobile vans). The objectives of these recommendations are to increase HIV screening of patients, including pregnant women, in health-care settings; foster earlier detection of HIV infection; identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services; and further reduce perinatal transmission of HIV in the United States. These revised recommendations update previous recommendations for HIV testing in health-care settings and for screening of pregnant women (CDC. Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings. MMWR 1993;42[No. RR-2]:1-10; CDC. Revised guidelines for HIV counseling, testing, and referral. MMWR 2001;50[No. RR-19]:1-62; and CDC. Revised recommendations for HIV screening of pregnant women. MMWR 2001;50[No. RR-19]:63-85). Major revisions from previously published guidelines are as follows: For patients in all health-care settings HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Persons at high risk for HIV infection should be screened for HIV at least annually. Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings. For pregnant women HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women. HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women.

Wesolowski LG, Sanchez T, MacKellar DA, Branson BM, Ethridge SF, Constantine N, Ketema F, Sullivan PS. · Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA 30333, USA. · Clin Vaccine Immunol. · Pubmed #19458205 No free full text.

Abstract: The CDC recommends that a reactive rapid human immunodeficiency virus (HIV) test be confirmed with an approved supplemental test; the performance of an intermediate enzyme immunoassay (EIA) is optional. In support of this recommendation, it was found that of 1,431 reactive rapid HIV test results, 2 (0.1%) had false-negative oral fluid Western blot results and both had false-negative EIA results.

Heffelfinger JD, Sullivan PS, Branson BM, Mastro TD, Purcell DW, Griffiths SD, Romaguera RA, Janssen RS. · Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, GA 30333, USA. · Public Health Rep. · Pubmed #19172707 No free full text.

This publication has no abstract.

Farnham PG, Hutchinson AB, Sansom SL, Branson BM. · Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-48, Atlanta, GA 30333, USA. · Public Health Rep. · Pubmed #19166089 No free full text.

Abstract: OBJECTIVES: In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine human immunodeficiency virus (HIV) screening for people aged 13 to 64 years in all U.S. health-care settings. Earlier recommendations focused on those at high risk for HIV and included more extensive pretest counseling. HIV screening may also involve either rapid or conventional testing. The purpose of this research was to estimate the costs of these different testing procedures and the cost per HIV-infected patient correctly receiving test results in three health-care scenarios that illustrated these policy differences. METHODS: The study estimated the costs of rapid and conventional HIV testing in the following scenarios: (1) sexually transmitted disease (STD) clinic counseling and testing (CT), (2) STD clinic screening, and (3) emergency department (ED) screening. Costs were estimated from the provider perspective in 2006 dollars. A decision analytic model was developed to estimate the cost per HIV-infected patient notified of test results using the two testing procedures in the three scenarios. RESULTS: Although the complete rapid testing procedure was more expensive than conventional testing, the cost per HIV-infected patient receiving test results was lower for the rapid test compared with conventional testing in all scenarios. Per-patient costs of receiving results were lowest in the ED screening scenario and highest in the STD CT scenario. These costs were sensitive to changes in test costs, HIV prevalence, and return rates following conventional tests. CONCLUSION: HIV screening in general health-care settings is economically feasible, particularly with rapid tests that lower the cost of HIV-infected patients receiving their test results.

Branson BM. · Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. · Clin Infect Dis. · Pubmed #18190290 No free full text.

Abstract: Diagnostic tests for human immunodeficiency virus (HIV) infection have undergone considerable evolution since the first enzyme immunoassay (EIA) and Western blot were introduced 2 decades ago. Newer methods detect infection sooner and yield results much faster. Rapid tests represent a major advance for HIV screening in the United States. Six rapid tests for detection of HIV antibody have been approved by the Food and Drug Administration (FDA) since November 2002. Four of these tests can be done in point-of-care and nonclinical settings because they use whole blood or oral fluid and are simple to perform. An assay for detection of HIV-1 RNA has been approved by the FDA to detect HIV infection before seroconversion has occurred and to confirm results of reactive screening tests; pooled testing of specimens for HIV-1 RNA has increased the cost-effectiveness of this screening tool. These new testing technologies offer unique opportunities to diagnose HIV infection among the estimated 252,000-312,000 persons in the United States who are currently unaware they are infected.