Nearly 1.2 million Americans are now living with HIV infection, and about 50,000 people become infected every year. Yet, 20 percent to 25 percent of people who have HIV do not know they are infected. People can reduce their chance of getting HIV by avoiding risky behaviors, such as injecting drugs or having unsafe sex. For people who are already infected, it is important that they find out early so they can begin treatment with antiretroviral therapy (ART).
Starting ART early—before symptoms appear—greatly reduces the risk of developing acquired immunodeficiency syndrome (AIDS, the final stage of HIV infection), having AIDS-related complications, or dying of AIDS. It also reduces the chance that a person with HIV will pass on the infection to someone else. Treating pregnant women dramatically reduces the chances that the virus will be transmitted to their babies.
HIV screening involves taking a blood sample. The sample is tested to see whether it contains antibodies (disease-fighting proteins) that react specifically to HIV. These tests are very accurate.
There is no cure for HIV infection, but it can be managed to help people live healthier and longer lives. Treatment includes medicines to fight the infection (ART), vaccinations against illnesses such as hepatitis B, and medicines to prevent infections that occur more easily if a person is infected with HIV.
Screening for HIV Infection
Because HIV infection does not usually cause symptoms at the early stage, people need to be screened to learn whether they are infected. People who are feeling well and learn they are infected can start treatment early and avoid giving the disease to other people.
Potential Benefits and Harms of Screening for Human Immunodeficiency Virus (HIV)
The Task Force reviewed studies on the benefits and potential harms of screening for HIV infection.
The Task Force found strong evidence that screening for HIV in teens, adults, and pregnant women has many benefits. Screening tells people who may not feel ill whether they are infected. If they are infected and start treatment, they have a better chance of staying healthy. Treatment can also reduce their chances of passing the infection to other people.
The Task Force found that potential harms are small. False-positive results (a result saying that a person is infected when, in fact, he or she is not infected) are rare. ART is associated with short-term harms, including side effects, but many of these may go away in time. For people who experience side effects, other ART drugs are available.
Long-term use of some ART medicines may increase the risk of heart disease and other health problems, but the Task Force found that this risk seems to be small.
It’s Importance and Significance For Our Community
Linkage to care is a crucial early step in successful HIV treatment and is typically defined as the completion of a first medical clinic visit after HIV diagnosis. Linkage to care plays a key role in the HIV care continuum—it is a necessary precursor to antiretroviral therapy initiation and viral suppression. Evidence clearly demonstrates that antiretroviral treatment significantly reduces the risk of developing HIV-related complications. In addition, antiretroviral therapy dramatically reduces HIV transmission to others. Without timely entry into care, individuals with HIV miss an opportunity to benefit from HIV treatment at the earliest stage feasible; rapid initiation of antiretroviral therapy after HIV diagnosis is a key pillar of the national initiative, Ending the HIV Epidemic: A Plan for America. In addition, delayed linkage to care is a major barrier to “treatment as prevention” to reduce HIV transmission rates in the United States. Thus, identifying persons with HIV and successfully linking them to care plays a key role in the overall HIV epidemic, both from a treatment and a prevention standpoint.
FACTORS ASSOCIATED WITH DELAYED LINKAGE TO CARE
Studies have consistently identified several factors that predict delayed linkage to care, including Black race, poverty, housing insecurity, lack of insurance or access to primary care prior to HIV diagnosis, substance use disorders, and mental health conditions. Additional risk factors for delayed linkage to care include psychosocial, emotional, and structural barriers. A 2009 national survey revealed that healthcare providers more often attributed non engagement in care to structural barriers (finances, transportation, family care, lack of time off from work, and substance use), whereas persons with HIV more often reported psychosocial issues (fear of people knowing their diagnosis, concern about medication side effects, stigma, and shame) as the most important barriers to care. Other barriers, such as inconveniently located medical services, long appointment wait times, and language barriers, also likely contribute to delayed linkage to care. Persons who are required to undergo HIV testing, such as for insurance, employment, or court-ordered purposes, have been found to delay linkage after receiving a diagnosis of HIV, compared with individuals who self-initiate testing or have HIV testing recommended by their medical provider.
LINKAGE BASED ON SITE OF TESTING
Although a multitude of barriers to HIV care have been identified, few randomized, controlled trials have evaluated interventions to overcome these barriers. Moreover, published studies that have evaluated linkage to care interventions have not used standardized outcomes, making comparisons between studies problematic.