The U.S. Preventive Services Task Force Will Soon Issue a Final Recommendation on HIV Screening for Adolescents and Adults

The U.S. Preventive Services Task Force Will Soon Issue a Final Recommendation on HIV Screening for Adolescents and Adults

By the Innovations Exchange Team, based on an interview with U.S. Preventive Services Task Force Member Douglas K. Owens, MD, MS

Introduction

The U.S . Preventive Services Task Force (USPSTF) issues evidence-based recommendations on preventive measures including screening for infectious diseases such as HIV. USPSTF recently reviewed the evidence from a systematic review of the literature and issued a draft recommendation that strongly recommends that clinicians offer HIV screening to all people between the ages of 15 and 65 years, pregnant women, and younger adolescents and older adults at high risk for HIV. The final recommendation is expected to be released soon.

Innovations Exchange: Can you explain the Task Force's interest in developing recommendations for HIV screening?

Douglas K. Owens, MD, MS: HIV is a critical public health problem affecting approximately 1.2 million people in the United States. Twenty to twenty-five percent of those people have not been tested and therefore are unaware that they are HIV-positive, which increases the risk of transmission to others. There are approximately 50,000 new cases of HIV annually, which is a significant public health problem. Almost all patients with untreated HIV infection eventually develop AIDS.

What is the purpose of the draft recommendation for HIV screening?

Screening is an important tool to identify people with HIV. Antiretroviral therapy (ART) is an effective treatment that can help people with HIV live longer, healthier lives and reduce the risk of transmitting the disease to others. Therefore, the recommendation is aimed at early identification of people already infected with HIV to help them stay healthy, delay the onset of AIDS, and reduce the risk of spreading the infection.

What is new in the draft recommendation?

In its draft recommendation, the Task Force proposed all adolescents and adults between the ages of 15 and 65 years be screened routinely for HIV by their clinicians. Younger adolescents and older adults who are at an increased risk for HIV infection should also be screened. The previous Task Force recommendation was to screen high-risk adolescents and adults and pregnant women. In 2005, when the Task Force made its last recommendation for HIV screening, the evidence for the benefits of screening was less strong.

What new evidence supported broadening the HIV screening recommendation to nearly everyone?

The literature contains more recent studies on the effectiveness of ART and the effect of ART on transmission. The key findings from the literature review are stronger evidence of the benefits of ART earlier in the course of HIV disease and better evidence of the effectiveness of ART in reducing HIV transmission to others.

How does the Task Force grade its recommendations?

Our recommendations are given a grade of A, B, C, D, or I for insufficient evidence based on the strength of evidence and magnitude of the net benefit (benefits minus harms). USPSTF recommends that clinicians offer and patients consider taking advantage of preventive services with a Grade of “A” or “B.” Services with a grade of “D” are those for which the Task Force believes, with moderate or high certainty, that there is no overall net benefit or the harms outweigh the benefits. The Task Force recommends that clinicians discourage the use of these services and that patients consider avoiding them. For services assigned a “C” grade, the Task Force believes that there is at least moderate certainty that the net benefit is small. The Task Force recommends that clinicians selectively offer this service based on professional judgment and patient preferences. Finally, the Task Force issues “I” statements when there is not enough high-quality evidence to determine the balance of benefits and harms.

The Task Force bases its recommendations on a complete systematic review of the medical literature compiled by researchers at an AHRQ-funded Evidence-Based Practice Center.

What grades did the draft HIV screening recommendations receive?

The proposed recommendations that clinicians screen everyone between the ages of 15 and 65 years and younger adolescents and older adults at high risk of HIV have a grade of “A.” The evidence was good and included consistent results from well-designed, well-conducted studies in representative populations that assess effects on health outcomes. The screening of pregnant women was also given a grade of “A” because USPSTF found there is convincing evidence that identification and treatment of HIV-positive women reduces the rate of mother-to-child transmission.

If the final recommendations are similar to the draft recommendations, will it make it easier for people to get HIV screening?

We think the recommendation to screen everyone for HIV between the ages of 15 and 65 years makes it easier for clinicians to have that conversation with patients. Clinicians can say to patients “we recommend that everyone in your age group be routinely tested for HIV,” which is less stigmatizing than talking with patients about risk factors and behaviors.

What are the policy implications of the new HIV screening recommendations?

The mission of USPSTF is to empower patients and health care professionals to make informed decisions about clinical preventive services. We recognize that many groups, including the Federal government, use our recommendations for making policy, but our focus remains on understanding what the evidence tells us about the clinical effectiveness of preventive services.

Do you have any final thoughts you'd like to share?

The most important message is that people not engage in risky behaviors that can lead to HIV. Having said that, we hope that screening is offered routinely to people with their awareness and understanding, that HIV testing will be less stigmatizing, and that people with HIV will obtain treatment. If the recommendation is implemented widely, it should reduce the rate of HIV infection.

For more information about the draft HIV screening recommendation, please visit the USPSTF Web site at http://www.uspreventiveservicestaskforce.org/uspstf/uspshivi.htm.
 

About Douglas K. Owens, MD, MS: Dr. Owens is Associate Director of the Center for Health Care Evaluation at the Veterans Affairs Palo Alto Health Care System; Henry J. Kaiser, Jr. Professor and Director of the Center for Health Policy in the Freeman Spogli Institute for International Studies; and Director of the Center for Primary Care and Outcomes Research in the School of Medicine at Stanford University. He is a general internist and a senior investigator at the Department of Veterans Affairs Palo Alto Health Care System. Dr. Owens's research focuses on technology assessment, cost-effectiveness analysis, evidence synthesis, and methods for clinical decisionmaking.

Disclosure Statement: Dr. Owens disclosed that he receives travel support from USPSTF to attend USPSTF meetings, receives Federal grant support for studying HIV screening, and in the past received payment to develop a continuing medical education lecture on HIV screening.

Publish Date: 04/10/13
Date Last Updated: 03/26/14

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