BACKGROUND: US guidelines recommend routine human immunodeficiency virus (HIV) screening of all adults and adolescents at least once. The population-level impact of this strategy is unclear and will vary across the country. METHODS: We constructed a static linear model to estimate the optimal ages and incremental impact of adding 1-time routine HIV screening to risk-based, prenatal, symptom-based, and partner notification testing. Using surveillance data and published studies, we parameterized the model at the national level and for 2 settings representing subnational variability in the rates and distribution of infection: King County, WA and Philadelphia County, PA. Screening strategies were evaluated in terms of the percent of tests that result in new diagnoses (test positivity), cumulative person-years of undiagnosed infection, and the number of symptomatic HIV/acquired immune deficiency syndrome cases. RESULTS: Depending on the frequency of risk-based screening, routine screening test positivity was maximized at ages 30 to 34 years in the national model. The optimal age for routine screening was higher in a setting with a lower proportion of cases among men who have sex with men. Across settings, routine screening resulted in incremental reductions of 3% to 8% in years of undiagnosed infection and 3% to 11% in symptomatic cases, compared with reductions of 36% to 69% and 41% to 76% attributable to risk-based screening. CONCLUSIONS: Although routine HIV screening may contribute meaningfully to increased case detection in persons not captured by targeted testing programs in some settings, this strategy will have a limited impact on population-level outcomes. Our findings highlight the importance of a multipronged testing strategy with continued investment in risk-based screening programs.
BACKGROUND: US guidelines recommend routine human immunodeficiency virus (HIV) screening of all adults and adolescents at least once. The population-level impact of this strategy is unclear and will vary across the country. METHODS: We constructed a static linear model to estimate the optimal ages and incremental impact of adding 1-time routine HIV screening to risk-based, prenatal, symptom-based, and partner notification testing. Using surveillance data and published studies, we parameterized the model at the national level and for 2 settings representing subnational variability in the rates and distribution of infection: King County, WA and Philadelphia County, PA. Screening strategies were evaluated in terms of the percent of tests that result in new diagnoses (test positivity), cumulative person-years of undiagnosed infection, and the number of symptomatic HIV/acquired immune deficiency syndrome cases. RESULTS: Depending on the frequency of risk-based screening, routine screening test positivity was maximized at ages 30 to 34 years in the national model. The optimal age for routine screening was higher in a setting with a lower proportion of cases among men who have sex with men. Across settings, routine screening resulted in incremental reductions of 3% to 8% in years of undiagnosed infection and 3% to 11% in symptomatic cases, compared with reductions of 36% to 69% and 41% to 76% attributable to risk-based screening. CONCLUSIONS: Although routine HIV screening may contribute meaningfully to increased case detection in persons not captured by targeted testing programs in some settings, this strategy will have a limited impact on population-level outcomes. Our findings highlight the importance of a multipronged testing strategy with continued investment in risk-based screening programs.
Authors: Christine M Khosropour; Julia C Dombrowski; Roxanne P Kerani; David A Katz; Lindley A Barbee; Matthew R Golden Journal: J Acquir Immune Defic Syndr Date: 2016-12-01 Impact factor: 3.731
Authors: A David Paltiel; Milton C Weinstein; April D Kimmel; George R Seage; Elena Losina; Hong Zhang; Kenneth A Freedberg; Rochelle P Walensky Journal: N Engl J Med Date: 2005-02-10 Impact factor: 91.245
Authors: Michael S Lyons; Christopher J Lindsell; Andrew H Ruffner; D Beth Wayne; Kimberly W Hart; Matthew I Sperling; Alexander T Trott; Carl J Fichtenbaum Journal: J Acquir Immune Defic Syndr Date: 2013-11-01 Impact factor: 3.731
Authors: Anne M Neilan; Richard Dunville; M Cheryl Bañez Ocfemia; Joshua A Salomon; Jordan A Francke; Alexander J B Bulteel; Li Yan Wang; Katherine K Hsu; Elizabeth A DiNenno; Rochelle P Walensky; Robert A Parker; Kenneth A Freedberg; Andrea L Ciaranello Journal: J Adolesc Health Date: 2018-01 Impact factor: 5.012
Authors: Andre F Dailey; Brooke E Hoots; H Irene Hall; Ruiguang Song; Demorah Hayes; Paul Fulton; Joseph Prejean; Angela L Hernandez; Linda J Koenig; Linda A Valleroy Journal: MMWR Morb Mortal Wkly Rep Date: 2017-12-01 Impact factor: 17.586