This is particularly important in the case of a low-prevalence but highly stigmatized disease, such as HIV infection. It is critical that health care providers be appropriately trained to assist patients in interpreting test results and facilitating appropriate follow-up. An excessive number of false-positive results could create psychological and financial problems for patients and providers. Even highly accurate tests may be reactive in the absence of disease, especially when prevalence of the disease is low. The performance of screening tests and confirmatory algorithms is critical to feasible implementation of HIV screening in emergency departments. During the past 3 years, the approval of rapid HIV tests, the newly recommended HIV screening policy, and advances in HIV management have motivated the transition from targeted HIV testing to universal HIV screening. Favorable treatment outcomes have transformed HIV infection from a fatal condition to a chronic disease with a life expectancy that exceeds 20 years from treatment initiation ( 5). Screening guidelines have become more aggressive because, in the era of potent antiretroviral therapy, timely diagnosis of HIV infection is critical to ensure maximal treatment benefits. The availability of rapid HIV tests has facilitated the implementation of such universal screening practices ( 2– 4). In 2006, the Centers for Disease Control and Prevention (CDC) revised guidelines for HIV screening to recommend that all adults and adolescents (age 13 to 64 years) be offered an HIV screening test in health care settings, including emergency departments ( 1).
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