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HIV Test Plan May Triple New Cases, Swamp Clinics, Doctors Say
  By John Lauerman
Nov. 28 (Bloomberg) -- Jim Raper and Michael Saag, who run an Alabama AIDS clinic, say their center may soon be overwhelmed by new U.S. guidelines urging that everyone aged 13 to 64 who visits a doctor be tested for HIV.
The recommendation is the first time HIV testing will be performed routinely in the 25-year AIDS epidemic in the U.S. It may triple U.S. diagnoses to 140,000 next year and prevent thousands of HIV infections afterwards, doctors say. The test results may also double life expectancy for infected people unaware they carry the virus.
Without extra money to add doctors, nurses and other staff at HIV clinics like the one in Alabama that treats low-income and uninsured patients, the proposal may hamper the quality of care, says Saag, a doctor who is the clinic's director. His center is running a $1.1 million deficit, and he says the new guidelines may add more than a 1,000 clients within 18 months, a 75 percent increase.
``We are already at the breaking point, and if you added just 20 percent of new volume to us we wouldn't be able to absorb it,'' says Saag, who has worked with HIV patients since his center opened in 1988. ``Our staff is nervous and scared.''
The U.S. Centers for Disease Control and Prevention recommended the added testing in June because it estimates that only two-thirds of 1.1 million Americans with HIV, or the human immunodeficiency virus, get care. That means as many as 300,000 may be sick and not know it, infecting others and letting their own health deteriorate. Saag will join dozens of health professionals meeting with U.S. officials in Washington tomorrow to discuss how to implement the new plan.
February Push
The CDC will begin a push to implement the guidelines in February during a series of HIV-testing workshops set for high- volume emergency departments and urgent care centers nationwide, says Bernard Branson, a CDC associate director. The agency will then move to hospitals and primary care clinics, he said.
Branson says the financial impact of the guidelines will be minimal and that newly identified infections will rise by only about 50,000 in 2007 from the 40,000 estimated for this year.
Many cases detected by the increased testing won't be advanced enough to require treatment with drugs made by companies such as Gilead Sciences Inc., GlaxoSmithKline Plc and Abbott Laboratories, he says. HIV drug sales in the U.S. in 2005 were led by Glaxo, with $1.5 billion, Gilead, with $847 million, and Abbott, with $420 million.
``I have a little difficulty with the perception that it's going to create costs,'' Branson says. The increase will be gradual, ``not a geometric increase.''
Federal Spending
John Bartlett, a Johns Hopkins University infectious disease expert who organized the meeting, disagrees. He says the testing will add twice as many new cases of AIDS, or acquired immune deficiency syndrome, as the CDC estimates, bringing the total number to 140,000. In such a scenario, U.S. costs alone may increase by $1.5 billion, he said.
In the fiscal year ending last June, federal spending on HIV care, along with state contributions, was about $17.4 billion, according to the Kaiser Family Foundation. That figure doesn't include spending by private insurers, says Jennifer Kates, the foundation's HIV policy director, as well as other funds that some states also contribute.
``The saying is pay now and save money later,'' says Bartlett. ``The problem is, we don't have the money now.''
Raper, a nurse-practitioner and clinic administrator, says his Alabama center, called The 1917 Clinic, may have to stop taking new patients as a result of the testing. Earlier this month, the clinic released a patient with potassium levels high enough to cause a heart attack, because blood testing results came back after the patient had left, Raper said.
More errors may occur as new testing brings hundreds of new patients in, Raper says.
`Can't Get it Done'
``There's only so long any system can function like this,'' he says. ``You can tell by my voice I've had about all I can take. You can't get it all done.''
The Birmingham clinic has a midwife, three nurses, and about 20 part-time doctors treating 1,400 patients a year, 75 percent more than in 1998, with no increase in the $500,000 a year the clinic receives from a federal program dedicated to HIV care, Raper said. The University of Alabama at Birmingham is covering the deficit, he says.
``There are already people calling every day asking for appointments,'' he says. ``As I see it, we're going to be limiting access to the clinic.''
Test Makers
Emergency rooms at hospitals may also be hobbled by testing, says Andrew Bern, an emergency doctor at the Delray Medical Center in Delray Beach, Florida.
Emergency departments will need many more of the HIV tests made by Bethlehem, Pennsylvania-based Orasure Technologies Inc., Medford, New York-based Chembio Diagnostics Inc. and others. While insurance covers some testing, the number of people without coverage is on the rise and hospitals are already facing financial pressures as the government seeks to cut overall health-care costs, Bern says.
``You have to create time for testing, counseling, and follow up to get patients into care,'' he says. ``Can it tie up an emergency room? Absolutely.''
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