Missed opportunities for earlier diagnosis of HIV infection--South Carolina, 1997-2005

In September 2006, CDC published revised recommendations for human immunodeficiency virus (HIV) testing in health-care settings to 1) increase early detection of HIV infection by expanding HIV screening of patients and 2) improve access to HIV care and prevention services (e.g., by conducting screening in locations such as emergency departments and urgent-care facilities, where persons who do not otherwise access HIV testing seek health-care services). HIV screening is now recommended for patients aged 13-64 years in all health-care settings after patients are notified that testing will be performed unless they decline (opt-out screening). This represents a substantial change from earlier recommendations to 1) offer HIV testing routinely to all patients only in health-care settings with high HIV prevalence and 2) conduct targeted screening on the basis of risk behaviors for patients in low-prevalence settings. This report examines HIV and acquired immunodeficiency syndrome (AIDS) case reporting in South Carolina before the 2006 recommendations were published. During 2001-2005, a total of 4,315 cases of HIV infection were reported in South Carolina. Of these, 41% were in persons (referred to as late testers) in whom AIDS was diagnosed within 1 year of their initial HIV diagnosis. Of these late testers, 73% made a total of 7,988 visits to a South Carolina health-care facility during 1997-2005 before their first reported positive HIV test. The diagnoses reported for 79% of these visits were not likely to prompt HIV testing under a risk-based testing strategy. These findings suggest that routine, opt-out HIV screening of all patients in health-care settings, rather than risk-based HIV testing, might result in substantially earlier HIV diagnoses in South Carolina.