August 19, 2013
New HIV screening guidelines ease access
By Dann Denny
New HIV screening guidelines issued by the government represent a significant step forward in the fight against HIV infection in the U.S., according to an Indiana University health policy expert.
"The guidelines will result in more HIV screenings because they will now be reimbursable," said Beth Meyerson, assistant professor of health policy and management in IU's department of applied health science. "The guidelines flipped the funding switch."
Meyerson said in 2006, the Centers for Disease Control and Prevention recommended that routine testing for HIV should be done in clinical settings -- such as doctors' offices, emergency rooms and clinics. But now, the U.S. Preventive Services Task Force has agreed with the CDC, and she said the testing will be covered by most private insurers as well as Medicaid in many states.
"The task force usually waits until several scientific studies have been done before it comes out with recommendations, but once it does, those recommendations become the standard of care, and the insurance companies start offering coverage," she said. "These recommendations have taken a lot of the burden off patients and providers, and will result in a lot more people getting screened."
The guidelines, issued in November, say clinicians should screen all people ages 15 to 65 for HIV infection, all pregnant women, and people younger than 15 and older than 65 if they are at an increased risk for infection. Some people will need only one screening, but others -- because of risk factors -- might require follow-up screenings at least annually.
21 percent of people who have HIV don't know they have it. "And because HIV has a long incubation period, a person might have it 10 years before showing any symptoms. In the meantime, they run the risk of infecting their sexual partner or partners," Meyerson said.
Meyerson said there is still work to be done, because many medical providers are reluctant to talk about HIV with their patients, and vice versa.
"Doctors don't know how to talk about sexual health with patients, and they don't want to upset their patients by asking, 'So who are you sleeping with?'" she said. "And patients don't want to talk about their sexual health with their doctors for fear of stigmatizing the relationship."
But she said because the new recommendations normalize HIV testing, it makes it easier for doctors to broach the topic -- saying something like, "If it's all right with you I'm going to test your blood for HIV, because I see in your medical records that you've not yet been tested. I'm not saying you're at risk for HIV, but running the test is now the standard of care for everyone.'"
Amanda Roach, spokeswoman for IU Health Bloomington Hospital, said the average charge for an HIV test at IU Health Southern Indiana Physicians offices is around $36.
"We always recommend patients check with their insurance company before any lab test or procedure to see if their particular policy will cover it," she said. "It's so hard to say whether or not any test or procedure is covered by insurance because plans and policies are all so different and vary from policy to policy."
Roach added that Positive Link, a program of IU Health Community Health in Bloomington that provides care coordination for those living with HIV/AIDS, offers free HIV testing to the community.
Meyerson said she and her colleagues recently finished a study on whether clinicians at Indiana's community health centers were routinely offering tests for HIV, STDs and cervical cancer to patients.
"The Affordable Care Act puts these centers front and center for helping the uninsured and under insured," she said. "But we found that clinicians were offering HIV testing only if the patient asked for it or was showing symptoms of HIV."
She said the new recommendations -- coupled with the ACA's provision that prevention services such as HIV testing be provided without cost or co-pay -- will get more doctors and patients talking to one another about HIV testing. That should lead to more diagnosis of HIV and ensuing treatment.
"We know that when people with HIV have access to treatment, they reduce the infectibility of their partner by 96 percent," Meyerson said. "Treatment is not a cake walk, but the good news is that more HIV testing and access to treatment will help reduce the spread of the HIV virus."
Meyerson and her colleagues recently conducted a small study in which they asked pharmacists in Indiana's cities and rural areas how they felt about possibly providing HIV testing, how they might provide it, and who they thought would take advantage of the testing if they offered it.
"If we are going to meet the National HIV/AIDS Strategy goals of reducing annual HIV infections by 25 percent and increasing the number of people who know their status to 90 percent by 2015, we are going to need to expand nonclinical options for HIV testing nationwide," she said. "The pharmacy system is evolving into an effective public health environment, and pharmacists are showing some interest in HIV testing. Pharmacies are ubiquitous, pharmacists are trusted, and the settings are destigmatizing in many ways. Plus, they are accessible -- 24/7 in some cases."
Meyerson said the study found that for the most part, pharmacists saw themselves as having a role in providing access to the test, saying they already give people vaccines for shingles and flu and other on-site testing. But the pharmacists issued a caveat -- that they would need significant training to equip them to consult with patients who got a positive HIV result.
"We feel that because HIV is still stigmatized, pharmacies will play a larger and larger role in the fight against HIV," she said. "When we talked to pharmacies, we found they had lots of understanding about the virus. We did not find much stigmatizing at all."