WASHINGTON — Only one in five federally funded safety-net health centers reported testing all patients ages 13 to 64 for HIV, despite a 7-year-old CDC recommendation to do so, a government report found.
Another 55% reported targeting high-risk patients for testing, the Department of Health and Human Services Office of Inspector General (OIG) stated in a report issued Monday. The high-risk testing is an approach aligning with recommendations from the U.S. Preventive Services Task Force.
Another 1% of sites reported testing all adults, but not teens. The remaining 24% of sites offered HIV tests only when patients requested it or had HIV symptoms, the report found.
The health centers, all of which received money from the federal Health Resources and Services Administration (HRSA), reported a lack of financial resources from patients and sites as one factor that limited their HIV testing.
“Respondents from one health center site reported that patients who were not eligible for free HIV tests were unlikely to pay for tests, and respondents from another health center site reported that patients had difficulty paying even the small office visit fee, let alone an additional testing fee,” the report said.
For its report, the OIG selected a random 500 health centers from among more than 8,100 sites that were receiving HRSA funding in November 2010. Of those, 149 were excluded because they did not provide primary care, they were no longer in operation, or their contractors did not respond to the OIG’s inquiries.
Of the remaining 351 eligible sites, the OIG received responses from 324. Those sites were surveyed from May 2011 to November 2011 on their compliance with four CDC recommendations from 2006 on HIV testing.
The recommendations significantly changed how primary care providers should provide HIV tests. The recommendations for providers — aimed to reduce the stigma of such testing and increase the number of people who know their status — included:
- Test all patients age 13 to 64 unless the patient has been previously tested for HIV or the prevalence of undiagnosed HIV is less than 0.1%.
- Don’t perform prevention counseling for all patients, because it is too time-consuming and causes them to be uncomfortable, which could limit testing.
- Offer consent for HIV tests in the same way as for other screening and diagnostic tests.
- Present HIV testing as a standard of practice for all patients unless they decline it, rather than making it an “opt-in” test.
A study published in November in Annals of Internal Medicine found that routine HIV screening has the potential to reduce sexual transmission of the virus.
The report also found that 29% of sites adopted the CDC’s recommended practice of not offering prevention counseling. When it came to gaining patient consent for HIV testing as with other tests, 27% adopted the practice, and 15% provided an HIV test as a standard, opt-out test, the report found.
HRSA funds grantees that administer clinics for community health, migrant health, homeless health, and public housing primary care. In 2011, such sites provided care to more than 17 million patients, and, with the CDC estimating one in five people in the U.S. living with HIV doesn’t know his status, HRSA centers can play a critical role in reducing the transmission of the virus, the OIG said.
To spur compliance with the CDC’s recommendations, the OIG recommended that HRSA require its health centers to determine the prevalence of undiagnosed HIV in the patient populations, adding that the agency also should require centers to report on their progress in determining prevalence.
Although the CDC recommends against routine testing if the prevalence is less than 0.1%, few health centers in the report tested enough patients to establish such a benchmark.
While they work to establish their patient populations’ HIV prevalence, health centers should also be required by HRSA to report the number of patients who have tested positive among all those tested at the site, the OIG recommended.
HRSA already requires its centers to report the number of tests provided. “However, HRSA does not collect information about how many of those HIV tests resulted in HIV-positive diagnoses,” Monday’s report noted.
HRSA does require clinics that receive funding through the Ryan White HIV/AIDS program — a HRSA program for HIV-positive patients who can’t afford care — track certain performance measures regarding HIV testing and care. “However, this requirement does not cover health center grantees that do not receive such funding,” the report said.