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Massachusetts Health agency urges routine HIV screening
  Recommends consent form be combined
By Elizabeth Cooney
Boston Globe Correspondent / June 25, 2009
Clearing the way for HIV testing to become almost as routine as checking for cholesterol, state public health officials issued an advisory yesterday saying that the written consent required by law can be included in general permission forms patients sign for medical care.
Until now, Massachusetts doctors have typically given patients separate consent forms to authorize HIV testing, but yesterday's directive makes clear that one form is sufficient, as long as the general consent form explicitly mentions HIV testing. Separate permission forms pose a barrier to testing for patients and healthcare providers alike, health officials said.
The new advice, issued by the state Department of Public Health, also recommends routine screening of people 13 to 64 years old in all healthcare settings, no matter what brings them to the hospital or doctor's office. People who fall into high-risk categories should be tested annually for HIV, the virus that causes AIDS.
The directive brings Massachusetts closer to federal guidelines promoted by the US Centers for Disease Control and Prevention in 2006 as a way to increase testing and reduce the spread of HIV. People who do not know they are infected - estimated to be about a quarter of cases - account for the majority of new HIV cases being transmitted, Kevin Cranston, director of the state Bureau of Infectious Disease, told the Public Health Council at its meeting yesterday. Along with a handful of other states, Massachusetts has balked at treating HIV testing like other tests, citing the stigma associated with the disease. Patients in Massachusetts must still choose to have HIV testing. That differs from CDC guidelines, which recommend that HIV testing be performed unless a patient opts out.
Streamlining the testing process should bring people to treatment earlier, when it can prevent progression to AIDS, said Dr. Lauren Smith, medical director of the Department of Public Health.
"The take-home message is 31 percent of folks diagnosed with HIV progress to AIDS within two months,? she said, citing Massachusetts figures from 2005 through 2007. "If this happened a decade ago, we might have tolerated that. Now that we have very effective treatments, that is inappropriate. I?m hoping that statistic alone will be enough to really prompt substantial change in my fellow clinicians.?
Dr. Stephen L. Boswell, president and chief executive of Fenway Health, called the push for more testing a worthwhile step, but one that needs to be implemented cautiously in order to protect patient confidentiality. "There are a fair number of people out there who are positive and don?t know it. I think this could significantly decrease the number and get them into good care,? he said.
"The major concern is one related to privacy. I believe it is a legitimate expectation for patients to have that this information will be kept private and the insurance companies won?t be using this information in any way that potentially compromises a patient's ability to keep or maintain insurance.? The process for obtaining written consent in Massachusetts has sometimes been cumbersome, HIV specialists said, including the practice of sending completed consent forms with test specimens to laboratories. That is not required, state officials said yesterday.
"Everybody agrees that it's important to get more people tested for HIV and there have been a lot of misconceptions out there about what specific written informed consent requires,? said Ben Klein, a senior attorney at Gay & Lesbian Advocates & Defenders in Boston. "The real purpose of written informed consent for HIV testing is that nobody should be tested for HIV without knowing it.? The Department of Public Health tried routine HIV screening at three pilot sites - the emergency room at Baystate Medical Center in Springfield and Dorchester House and Codman Square community health centers in Boston - and it saw steep jumps in the number of HIV tests, many among high-risk groups.
Adding HIV testing to routine care has brought more young men into testing than before, Cranston said. But the $14 rapid test has costs, in people needed to administer the test, laboratory technologists to read them, and HIV case managers or doctors to counsel patients if the results are positive, said Dr. Jonathan Pincus, a primary care physician at Codman Square Health Center.
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