Opt-out testing for human immunodeficiency virus in the United States - Progress and challenges
Opt-out testing for human immunodeficiency virus in the United States - Progress and challenges
复制标题
DOI：
10.1001/jama.300.8.945
复制
发表时间：
2008-08-27
影响因子：
120.7
通讯作者：
Mayer, Kenneth H.
中科院分区：
文献类型：
--
作者：
Bartlett, John G.;Branson, Bernard M.;Mayer, Kenneth H.
美国疾病控制和预防中心（CDC）建议在所有卫生保健机构中对13至64岁的所有人进行人类免疫缺陷病毒（HIV）检测。不需要签署同意书，并将与其他严重情况一样进行转诊咨询。这些建议的目标是促进早期就医，以减少不必要的死亡，并通过在了解血清状态的同时改变行为来促进预防。对这一变化的担忧包括一些州的法律要求签署同意书和咨询，认为咨询是一种有效的预防策略，检测支付范围的变化，对可能伴随艾滋病毒诊断的耻辱和歧视的担忧，以及其他检测政策可能更有效的可能性。16个州中有11个州修改了立法以减少检测障碍，74个国家专业协会中有35个支持新的建议，多个示范项目已显示出可行性。评估美国疾病控制与预防中心建议的艾滋病毒检测的健康结果的指标已经确定，但确定对早期接受治疗的影响、疾病发病率的实际减少以及意想不到的后果所需的数据尚未获得。
The Centers for Disease Control and Prevention ( CDC) has recommended human immunodeficiency virus ( HIV) testing for all persons aged 13 to 64 years in all health care settings. Signed consent would not be required and counseling with referral would be managed as it is for other serious conditions. The goal of the recommendations is to promote earlier entry into care to reduce unnecessary mortality and facilitate prevention by behavioral changes that accompany knowledge of serostatus. Concerns about the change include laws in some states that mandate signed consent and counseling, a perception that counseling is an effective prevention strategy, variability in payment coverage for the test, concerns about the stigma and discrimination that may accompany the HIV diagnosis, and the possibility that other testing policies would be more effective. Eleven of 16 states have changed legislation to reduce barriers to testing, 35 of 74 national professional societies have endorsed the new recommendations, and multiple demonstration projects have shown feasibility. Metrics to evaluate the health outcomes of the CDC's recommendations for HIV testing have been defined, but the data necessary to determine the effects on early entry into care, the actual reduction in disease incidence, and the unanticipated consequences are not yet available.