Objective 3: Increase the number of providers who routinely provide voluntary, client-centered counseling and testing (VCT) in health care settings (e.g., STD clinics, substance abuse treatment programs, family planning clinics, emergency rooms, community health centers), as well as in non-clinical venues (e.g., social venues, public assistance programs, street outreach).

CDC is currently revising recommendations for HIV testing of adults, adolescents and pregnant women in health care settings. These will update previous recommendations with the intended purpose of increasing routine, voluntary HIV screening of patients in health care settings. Further, CDC expects the new recommendations will result in substantial increases in HIV testing and increases in the proportion of persons who know their HIV status. Key elements of these recommendations include: 1) Routine, voluntary HIV screening in all health care settings, (cost-benefit analyses have shown the routine HIV screening is cost-effective at HIV seroprevalence rates as low <0.1%); 2) Normalization of HIV testing -- meaning that HIV testing should be incorporated into the routine medical screening panel at that facility; 3) Incorporation of informed consent for the HIV test into the facilities' general medical consent process with an “opt-out” approach, whereby the patient can specifically decline the HIV test if so desired; 4) Strong encouragement of prevention counseling in settings where risk behaviors are routinely ascertained (e.g., STD clinics), but counseling does not have to be linked to routine screening in health care settings.

Objective 4: Increase the percentage of people who know their results after testing.

One AHP demonstration project focused on the use of rapid HIV testing among high-risk populations in nonclinical settings. The “Routine Rapid HIV Testing of Inmates in Short-Stay Correctional Facilities,” was targeted to persons entering the correctional system. High rates of HIV and STDs have been documented among this group of people, and currently, only a fraction of jails routinely test for HIV on entry. People incarcerated for less than 30 days are unlikely to receive traditional HIV counseling and testing, and, if they do, they may be released before their test results from traditional testing are available. Routine rapid testing would facilitate initial testing, delivery of results, confirmatory testing, and appropriate referral to care, treatment, and prevention services within the facility or in the community. CDC funded s tate health departments in Florida, Louisiana, New York, and Wisconsin to assess the feasibility of rapid HIV testing in short-stay correctional facilities. From January 2004 through March 2005, 16,676 inmates were tested and 256 (1.5%) were reactive.

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