Recommendations for HIV Testing Services for Inpatients
and Outpatients in Acute-Care Hospital Settings
CDC has published revised recommendations for human
immunodeficiency virus (HIV) counseling and testing of patients in
acute-care hospital settings (1).* These recommendations update
previous CDC guidelines published in 1987 (2) and strengthen the
recommendation for hospitals to assess the rate of HIV infection
among their patient populations and to develop HIV-testing programs
that assist infected patients in obtaining HIV-related treatment
and
prevention services. The revision was prompted by information
regarding both the rates of previously unrecognized HIV infection
among persons admitted to some acute-care hospitals and the
potential
medical and public health benefits of recognizing HIV infection in
persons who have not developed acquired immunodeficiency syndrome
(AIDS).
CDC recommends that hospitals and associated clinics encourage
health-care providers to routinely ask patients in nonemergency
settings about their risks for HIV infection. Patients at risk
should
be offered HIV counseling and testing services with informed
consent
obtained in accordance with local laws. In addition, hospitals with
an HIV-seroprevalence rate of at least 1% or an AIDS diagnosis rate
greater than or equal to 1.0 per 1000 discharges (3) should
strongly
consider adopting a policy of offering such services routinely to
patients aged 15-54 years. These services should be structured to
facilitate confidential, voluntary patient participation and should
include pretest information about the testing procedures,
appropriate
posttest counseling for infected patients and those at increased
risk, and referral of HIV-infected persons for medical evaluation.
Persons who decline HIV testing or who consent to testing and are
found to be infected must not be denied needed health care or
provided suboptimal care.
The recommendations emphasize that HIV counseling and testing
programs should not be used as a substitute for universal
precautions
or other infection-control techniques and underscore the importance
of effective and ongoing collaboration between acute-care providers
and health departments to improve HIV-related prevention and
treatment services.
References
CDC. Recommendations for HIV testing services for inpatients and
outpatients in acute-care hospital settings and technical guidance
on HIV counseling. In: Recommendations and reports (January 15).
MMWR
1993;42(no. RR-2):1-6.
CDC. Public Health Service guidelines for counseling and
antibody
testing to prevent HIV infection and AIDS. MMWR 1987;36:509-15.
Janssen RS, St. Louis ME, Satten G, et al. HIV infection among
patients in U.S. acute-care hospitals: strategies for the
counseling
and testing of hospital patients. N Engl J Med 1992;327:445-52.
Single copies of the recommendations will be available from the
CDC
National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD
20849-6003;
telephone (800) 458-5231.
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