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HIV Testing Program in Mass. Wins Praise

It offers voluntary screening as part of routine medical care

THURSDAY, June 24, 2004 (HealthDayNews) -- A Massachusetts program that offered voluntary HIV testing as part of routine medical care to patients who came to urgent care centers is being hailed as an innovative way to combat the AIDS epidemic.

The state's Department of Public Health set up the program, which offered testing, counseling, and referral treatment to patients entering one of four hospital-associated urgent care centers. All of the patients who learned they were positive for HIV, the virus that causes AIDS, had at least one follow-up visit for HIV care -- an amazingly high number, HIV experts said.

A review of the program appears in the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, released Thursday.

Massachusetts health officials selected sites they suspected would have high HIV rates, said Dr. Rochelle Walensky, assistant professor of medicine at Harvard Medical School and Massachusetts General Hospital, and lead author of the report.

"Of every 100 tests, we found approximately two were positive," she said. "That is extraordinarily high. We found a large number of patients who didn't know they were infected."

Such expansion of routine, voluntary testing is one of the strategies set out in the AIDS initiative the CDC released in April 2003. The Massachusetts program may serve as a model for other communities, officials said.

In creating the program, the Massachusetts Department of Public Health first identified the 15 cities with the highest rates of HIV, then selected four hospital-associated urgent care centers in which to implement the program, called "Think HIV."

In the program's first year, more than 10,000 patients were offered HIV testing and 3,000 agreed to it. Of those, 60 tested positive and 49 -- or 82 percent -- returned for their results.

Of the first 42 patients for whom data exist, all had at least one documented follow-up visit for HIV care, the study found.

The return rate for care was much higher, the authors note, compared to a recently reported program in which just 34 percent of people who tested positive for HIV and returned for their results also came back for medical care.

One reason for the high number of return visits may be that nurses at each site helped set up the follow-up visit appointments, and actually took patients to those appointments, the authors said.

The program is not only effective but cost-effective, said Walensky.

"We estimated that the cost per case identified was less than $6,000," she said. From a public health point of view, she added, "this is an efficient use of resources compared to other diseases [such as breast cancer] that we screen for."

Lee Klosinski, director of programs for AIDS Project Los Angeles, applauded the report describing the new program. "I think this is a good, imaginative way of getting people tested," he said.

"What was modeled strongly was the ability of getting people who tested positive to get into care. One hundred percent got into care. That's simply astonishing."

What's also crucial, he added, "is to develop strategies that catch people at the earliest stage of disease progression."

Even people well-educated about the risks of HIV and AIDS, he said, ignore advice to get tested if they engage in high-risk behavior. Or, they get tested, receive a negative result, and then engage in high-risk behavior but don't get tested again -- and end up HIV-positive.

"Fear remains the number one reason people don't want to get tested," Klosinski said. Offering the tests during routine medical care, he said, works partly due to the convenience. "It doesn't involve another appointment," he said.

According to the CDC, about 886,000 people in the United States had been diagnosed with AIDS through 2002. Worldwide, about 40 million people are estimated to be living with HIV/AIDS, the agency said.

More information

For more on HIV/AIDS, visit the National Library of Medicine.

SOURCES: Rochelle Walensky, M.D., M.P.H., assistant professor of medicine, Harvard Medical School and Massachusetts General Hospital, Boston; Lee Klosinski, Ph.D., director of programs, AIDS Project Los Angeles; June 25, 2004, Morbidity and Mortality Weekly Report, U.S. Centers for Disease Control and Prevention
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