Key Info
HIV testing is integral to HIV prevention, therapy, and care. Data of 1’s HIV standing allows people to interact in HIV therapy and is essential for stopping transmission. Whereas the share who know their HIV standing has elevated over time, as of 2021, 13% of individuals with HIV didn’t know they have been HIV constructive. Research present that those that be taught they’re HIV constructive modify their conduct to scale back the danger of HIV transmission and that those that have no idea they’re constructive account for practically 40% of recent HIV infections.
In 2022, solely a few third (36%) of nonelderly adults in america (U.S.) had ever been examined for HIV. The Facilities for Illness Management and Prevention (CDC) recommends that everybody aged 13-64 be examined for HIV no less than as soon as as a part of routine well being care, and no less than yearly for these at increased threat.
Early data of HIV standing permits for linkage to medical care and therapy that may scale back morbidity and mortality and enhance high quality of life. Remedy pointers suggest beginning antiretroviral therapy as quickly as one is recognized with HIV. People with HIV who’ve an undetectable viral load, achieved by way of used of efficient antiretroviral remedy, can’t sexually transmit HIV to others.
Most individuals with medical health insurance – each private and non-private – have entry to HIV testing, usually for gratis. And, for these with out insurance coverage, HIV testing can usually be obtained at little or no price in group settings.
Testing Statistics
By earlier detection, elevating consciousness of HIV standing, and linkage to care and therapy, testing performs an essential function in addressing the U.S. epidemic.
Among the many 2 million folks with HIV within the U.S., an estimated 13% have no idea they’re HIV constructive and this share accounts for practically 40% of recent transmissions. Consciousness of HIV standing permits those that are constructive to interact in HIV therapy, scale back viral load (the quantity of virus within the physique) and stop transmission. Moreover, research present that those that be taught they’re HIV constructive modify their conduct to scale back the danger of HIV transmission.
In keeping with the CDC’s Behavioral Threat Issue Surveillance System (BRFSS), in 2022, 3 in 10 (36%) U.S. adults, aged 18-64, reported ever having been examined for HIV (see Determine 1). HIV testing charges differ by state, age, race/ethnicity, and different elements. Some communities of shade report having ever been examined for HIV at increased charges than White folks. For instance, 57% of Black folks and 44% of Hispanic folks report ever having been examined for HIV in comparison with 32% of White folks. However Asian folks, Native Hawaiian and Pacific islanders as a gaggle report decrease charges of testing (26%), probably reflecting decrease charges of HIV on these communities. (See Determine 1.)
The newest KFF survey discovered that 37% of homosexual and bisexual males report being examined previously two years.
Testing Suggestions and Necessities
Since 2006, the CDC has really useful that everybody aged 13-64 obtain no less than one HIV check as part of routine well being care and extra frequent testing, no less than yearly, for these at increased threat. Per the CDC, people who could profit from no less than annual screening embrace:
sexually lively homosexual or bisexual males (a few of whom could profit from extra frequent testing, reminiscent of each 3 to six months)
people who’ve had intercourse with an HIV-positive associate
people who’ve had multiple associate since their final HIV check
those that have shared needles or works to inject medication
individuals who have exchanged intercourse for medication or cash
people who’ve one other sexually transmitted illness, hepatitis, or tuberculosis
those that have had intercourse with somebody who has participated in any of the above actions or with somebody with an unknown sexual historical past
Moreover, HIV testing is really useful for:
anybody who has been sexually assaulted at authentic evaluation, repeating at 6 weeks and three months
all pregnant folks and for any new child whose mom’s HIV standing is unknown (therapy offered to pregnant HIV-positive folks early in being pregnant can scale back the danger of transmitting HIV to 1% or much less)
anybody who’s PrEP, repeating each 3 months
those that have an occupational publicity, reminiscent of healthcare personnel, to blood and/or different physique fluids which will comprise HIV
native insurance policies and suggestions can also inform or facilitate HIV testing. For instance, in New York state, it necessary to supply HIV testing to sufferers within the emergency room division, inpatient departments of hospitals, and first care facilities.
CDC recommends that each one HIV screening be voluntary, and opt-out (affected person is notified that the check will likely be carried out and consent is inferred except the affected person declines) vs. opt-in (check is obtainable to the affected person who should explicitly consent to an HIV check, usually in writing).
HIV testing is necessary within the U.S. in sure circumstances, together with for: blood and organ donors; navy candidates and lively obligation personnel; federal and state jail inmates beneath sure circumstances; and newborns in some states. As of January 2010, HIV testing is not necessary for these wishing to to migrate to america or for refugees.
All states/territories have moved to HIV title reporting (along with reporting AIDS circumstances) the place an individual’s title is reported to the state in the event that they check HIV constructive. The state then studies the variety of distinctive constructive HIV assessments to CDC (no names or different personally figuring out data are reported to CDC; solely medical and fundamental demographic data are forwarded). That is thought-about confidential HIV testing. There may be additionally nameless HIV testing supplied at some testing websites the place figuring out data will not be collected/reported.
Insurance coverage Protection of HIV Testing
Most insurers now broadly cowl HIV testing as a part of routine healthcare with out cost-sharing because of the Reasonably priced Care Act (ACA). Underneath the ACA, any preventive service given an “A” or “B” score by america Preventive Companies Activity Drive (USPSTF) have to be lined by most insurers with out cost-sharing; as well as, conventional Medicaid packages, whereas not required to offer USPSTF high graded providers, are incentivized to take action. In 2013, the USPSTF gave HIV screening an “A” score for all adolescents and adults, ages 15 to 65. It additionally gave an “A” grade to HIV screening for pregnant ladies. Each of those suggestions have been reaffirmed in 2019. The present insurance coverage protection panorama of HIV testing is as follows:
Personal Insurance coverage: Most non-public plans cowl routine HIV testing with out cost-sharing. All plans created after the ACA was signed in 2010 should present protection aligning with the USPSTF “A” and “B” grades with out price sharing.
Medicaid: All Medicaid packages cowl “medically essential” HIV testing and most cowl routine HIV screening. Every state Medicaid program determines its personal definition of medical necessity, though it usually refers to procedures really useful by a doctor. Within the case of HIV testing, it’s clinically indicated based mostly on a affected person’s threat elements and/or indicators of HIV an infection.
Conventional Medicaid Applications: Whereas all Medicaid packages should cowl “medically essential” HIV testing, protection of “routine” HIV screening is an elective profit in conventional (non-expansion) Medicaid packages. Nonetheless, most states do cowl routine HIV screening. In a 2021 survey, of 42 responding jurisdictions, 40 states and DC (41 complete) reported masking routine HIV testing. Only one state, Florida, reported masking “medically essential” testing. 9 states didn’t reply, together with 3 that reported masking solely “medically essential” testing in a previous survey (GA, NE, and SD).
As of November 2021, among the many 42 states that cowl routine HIV screening, 16 (CA, CO, DE, HI, KY, LA, MA, MT, NH, NJ, NV, NY, OH, OR, WA and WI) cowl all USPTSF “A” and “B” graded providers and have sought an extra 1% improve of their federal matching fee (FMAP) for these providers beneath Sec. 4106 of the ACA.
Medicaid Enlargement Applications: Along with masking medically essential testing, Medicaid packages expanded beneath the ACA are required to cowl preventive providers rated “A” or “B” by the USPSTF, together with HIV screening, with out cost-sharing. So far, 40 states and DC have expanded their Medicaid packages.
Medicare: In April 2015, following the 2013 USPSTF suggestion and a subsequent Nationwide Protection Dedication, CMS expanded Medicare protection to incorporate annual HIV testing for beneficiaries ages 15-65 no matter threat, and people outdoors this age vary at elevated threat with out cost-sharing. Moreover, Medicare will cowl as much as three assessments for pregnant beneficiaries.
Uninsured: For these with out insurance coverage protection (or wishing to not use their insurance coverage), HIV testing could be obtained at little or no price in some group based mostly settings (e.g., stand-alone HIV testing websites, group well being facilities, cell testing clinics).
Testing Websites
HIV testing is obtainable at CDC-funded testing websites (accounting for about 1.7 million assessments in 2021) and in different private and non-private settings, together with free-standing HIV counseling and testing facilities, well being departments, hospitals, non-public physician workplaces, STD clinics, and cell testing items. The general positivity fee at CDC funded check websites was 1.1% in 2021. The positivity fee for brand new diagnoses was 0.5% however was considerably increased for sure sub-populations (e.g. 1.4% for transgender folks, 1.9% for males who’ve intercourse with males and a pair of.8% for males who’ve intercourse with males and likewise use injection medication). Amongst CDC-funded testing websites, non-health care amenities have the next fee of shoppers testing HIV constructive than do well being care and correctional amenities.
HIV testing is a part of the Ending the HIV Epidemic Initiative (EHE), a federal effort launched in 2019 to scale back new HIV infections in america by 75% in 5 years and 90% in ten years. HIV testing as a part of the EHE is basically performed by way of Well being Assets and Companies Administration (HRSA) funded Well being Facilities. Previous to EHE in 2018, HRSA funded Well being Facilities performed 2,427,075 HIV assessments. Between 2018 and 2022, there was a 44% improve in HIV assessments as over 1,000,000 extra sufferers have been examined in 2022 (3,492,034).
Testing Methods
HIV assessments purpose to detect the virus by on the lookout for proof of the physique’s immune response (antibodies), proteins on the floor of the virus (antigens), or genetic materials from the virus (RNA). Detectable antibodies often develop inside 3-8 weeks after an infection however could take longer; the interval after preliminary an infection with HIV earlier than detectable antibodies develop is the “window interval.”
In 2010, the FDA authorized the primary HIV diagnostic check that detects each antibodies and antigen, a part of the virus that triggers the manufacturing of antibodies. In 2013, the FDA authorized the primary speedy antigen-antibody check, the primary check additionally to tell apart between acute and established HIV-1 an infection. Exams for antigen permit for earlier detection of HIV as a result of they will detect the virus earlier than the physique has mounted a response, though there’ll nonetheless be a window interval of roughly two weeks after preliminary an infection throughout which no check can detect the virus. RNA, or nucleic acid assessments, which detect the virus itself within the blood, are additionally out there, however not routinely used for screening. The check could also be utilized in circumstances the place there was a high-risk publicity to HIV as a result of they can detect the virus earliest in an infection, as a follow-up check to a constructive antibody or antigen check and at the moment are really useful in sure circumstances as a part of evaluation for PrEP.
HIV diagnostics in the united statesdiffer based mostly on kind of specimen examined (entire blood, serum, or plasma; oral fluid; urine); how the specimen is collected (blood draw/venipuncture; finger prick; oral swab; through urination); the place the check is finished (laboratory; point-of-care web site; at residence); and the way shortly outcomes can be found (typical or speedy). The primary varieties of assessments are:
Standard Blood Check: Blood pattern drawn by well being care supplier; examined at lab. Outcomes: lower than an hour to a number of days.
Standard Oral Fluid Check: Oral fluid pattern collected by well being care supplier, who swabs inside mouth; examined at lab. Outcomes: just a few days to 2 weeks.
Fast Exams: Entire blood finger prick or venipuncture; plasma; oral fluid pattern collected relying on complexity of speedy check and particular person administering check. Outcomes: roughly 10 minutes. If check is unfavourable, no additional testing is required. If constructive, check have to be confirmed with a extra particular check by way of typical methodology. Some speedy assessments have been granted CLIA waivers which permit them for use outdoors conventional laboratories.
Self and Residence Exams: There may be one FDA authorized self-test, which is a speedy oral fluid check. Outcomes: roughly 20 minutes. The second FDA check is collected at residence and carried out with a finger prick with a lancet, inserting two drops of blood on a handled card, and mailing to a lab for testing. An identification quantity on the cardboard is used when phoning for outcomes; counseling and referral can be found by cellphone. Outcomes: in roughly three days. Self or residence testing could assist deal with some boundaries to HIV testing which will make some folks extra hesitant to entry in individual well being providers.
Urine Check: Urine pattern collected by well being care supplier; examined at lab. Outcomes: just a few days to 2 weeks.
After an HIV Check
Following an HIV check, people who check constructive can anticipate a confirmatory check and linkage to HIV care and therapy. It’s endorsed to provoke antiretroviral therapy as quickly as potential after analysis. Doing so facilitates the very best medical outcomes for the HIV constructive particular person and can be a prevention alternative, as as soon as that particular person has an undetectable viral load HIV can’t be transmitted to others. People who check HIV unfavourable however who’re at excessive threat for the an infection, could also be referred to extra prevention providers reminiscent of PrEP which might scale back the danger of HIV acquisition by way of intercourse by about 99%.
