HIV Screening and Early Diagnosis

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The HCPLive Peer Exchange: Optimizing Outcomes in HIV Treatment features insight and opinion on the latest developments in HIV research, diagnosis, and management from leading physician specialists.

This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Collegeville Family Practice in Collegeville, PA, and Medical Director of health services at Ursinus College, also in Collegeville, PA.

The panelists are:

• Alfred A. DeLuca, MD, Infectious Disease Specialist at CentraState Healthcare System in Manalapan, NJ
• Ian Frank, MD, Director of Anti-Retroviral Clinical Research and Director of Clinical Core at Penn Center for AIDS Research, and Professor of Medicine at the Hospital of the University of Pennsylvania in Philadelphia, PA
• Paul Sax, MD, Associate Professor of Medicine at Harvard Medical School and Clinical Director of the Division of Infectious Diseases and the HIV Program at Brigham and Women's Hospital, in Boston, MA

Also participating via video is Amir Qaseem, MD, Director of Clinical Policy for the American College of Physicians, based in Philadelphia, PA.

In this segment, Qaseem talks about the advantages of conducting HIV screening in primary care as part of a routine testing program. He notes that in most states patients can opt-out of HIV screening.

Qaseem also identifies several barriers to HIV screening, including physicians’ perception of the risk level of the patients they treat, time constraints, and funding and reimbursement issues. Physician discomfort when it comes to discussing positive results is another potential barrier to screening.

When it comes to home HIV testing, Qaseem says, “the benefit of a home test is at least that some of the patients who may not be willing to go to their clinician and may not be getting tested at the primary care physician or any other place where they’re getting the healthcare for the HIV, they can at least get the home test done.” However, one drawback is that a positive test puts the onus on the patient to reveal it to his or her physician and then come to the office for confirmatory testing and follow up.