HIV Testing Strategies for Health Departments to End the Epidemic in the U.S.

Abstract

An important goal of the Ending the HIV Epidemic in the U.S. initiative is the timely diagnosis of all people with HIV as early as possible after infection. To end the HIV epidemic, health departments were encouraged to propose new and innovative HIV testing strategies and improve the reach of existing programs. These activities were divided into 3 core strategies: expansion of routine screening in healthcare settings, locally tailored HIV testing initiatives in nonhealthcare settings, and specific efforts to increase the frequency of testing for individuals with increased potential for acquiring HIV. Because HIV testing is such a crucial part of the core activities of the Centers for Disease Control and Prevention's HIV prevention programs, there are many examples of evidencebased programs and best practices for HIV testing in both clinical and nonclinical settings. This article reviews the evidence base for these strategies and some of the activities proposed under the Diagnose pillar to achieve the goal of diagnosing all HIV infections as early as possible. All other Ending the HIV Epidemic in the U.S. activities start with an awareness of HIV status, which is actually the indicator for which most health departments are closest to the proposed targets. There are both proven and emerging approaches to increasing HIV screening and increasing the frequency of HIV screening available. The Ending the HIV Epidemic in the U.S. initiative provides the motivation, the resources, and a coordinated plan to bring them to scale.

Using the Index of Concentration at the Extremes to Evaluate Associations of Income and Black-White Racial Segregation with HIV Outcomes Among Adults Aged ≥18 Years — United States and Puerto Rico, 2019

“…Our findings of higher percentages of HIV testing in more deprived communities can be explained by CDC-funded testing efforts being focused on high-priority populations, and this testing might partially explain the higher HIV diagnosis rates in these communities. However, SDOH factors shaped by income, education, wealth, and childhood and neighborhood socioeconomic conditions, which vary systematically by race/ethnicity groups, might also explain higher diagnosis rates as well as our finding of lower percentages of linkage to care and viral suppression in these communities (14,22,23). These findings suggest spatial social polarization, as demonstrated by the ICE measures, might contribute to poor HIV outcomes and disparities for Black adults by segregating them in more deprived communities (14).…”

Concurrent Testing for COVID-19 and HIV Infection at 6 High-Volume Emergency Departments in a Priority Jurisdiction for Ending the HIV Epidemic in the United States

“…49,50 If adopted in a widespread manner, these strategies may help achieve HIV elimination goals. 11,13,26 This study has several limitations. Given that the analysis was limited to one geographic area, the results may not be widely applicable as local HIV epidemics vary quite widely.…”

“…49,50 If adopted in a widespread manner, these strategies may help achieve HIV elimination goals. 11,13,26…”

“…11 Routine HIV screening is a key testing strategy endorsed by the CDC as a high impact, cost-effective prevention intervention for increasing the number of PLWH aware of their diagnosis. [12][13][14] Despite the recommendation, universal HIV screening rates remain low in the United States, even in high incidence areas. 15 Health care settings that had been able to successfully implement routine HIV screening programs experienced setbacks as resources were shifted to the COVID-19 response.…”

Rapid, point-of-care antigen and molecular tests base on CRISPR for diagnosis of HIV-1 infection

“…The major HIV-1 strain in China is CRF07_BC (accounted for 41.3%), followed by CRF01_AE (32.7%), CRF08_BC (11.3%) and subtype B (4.0%) [3,4] . Many new approaches of HIV treatment have been con rmed effectively, but the researchers are still slowly getting closer to nding a true cure or useful vaccine to this disease, life-long antiviral treatment is required and necessary for AIDS/HIV patients at least in quite a long future [5][6][7] . So the current strategy of AIDS/HIV prevention and control still focuses on stopping the virus transmission, and methods for accurate and quick detection are of great vital for the successful implementation of this strategy.…”