To the Editor: In their Special Communication, Dr Bartlett and colleagues1 noted that the benefits and harms of the Centers for Disease Control and Prevention (CDC) recommendations for opt-out testing for human immunodeficiency virus (HIV) in health care settings have yet to be systematically assessed. Although the authors listed some possible metrics, their suggestions did not emphasize several critical potential outcomes and effects of opt-out testing.
I believe that the metrics must include the following: (1) percentage of persons living with HIV aware of their serostatus; (2) percentage of persons newly diagnosed with HIV receiving high-quality, comprehensive health care that includes, but is not limited to, HIV-specific services; (3) percentage of persons testing positive who receive evidence-based, patient-centered HIV prevention services to avoid transmission; (4) percentage of persons testing HIV seronegative but at imminent risk of infection who receive evidence-based, patient-centered HIV prevention services; (5) percentage of persons (stratified by serostatus) reporting changes in HIV risk behavior (metrics should capture magnitude and direction of behavioral change); (6) percentages of persons receiving their test results, understanding the results, and knowing their risk for transmission or infection (it is critical to ensure that persons who test HIV seronegative—or who do not receive their test results—not automatically infer that they are at no risk for infection or transmission); (7) percentage of persons who knew they were tested for HIV and the percentage who provided informed consent; (8) percentage of persons not holding stigmatizing attitudes about HIV; and (9) percentage of persons not experiencing HIV-related discrimination.
The authors include distal effects such as HIV incidence.1 It is also appropriate to include the distal outcomes HIV transmission rates, survival time, and quality of life. The cost-effectiveness of the services must be assessed to determine how to maximize favorable outcomes given constrained resources.
The authors omitted key references that support the evidence basis for patient-centered counseling surrounding HIV testing.2 - 4 For example, the CDC Web site lists brief counseling as a “best-evidence” HIV prevention intervention. Finally, the authors asserted that in my economic analysis of various HIV testing policies,5 the targeted testing policy would miss patients who do not feel they are at risk of infection. The targeted testing policy I analyzed does not rely on self-reported risk behaviors for targeting, but rather on indicators of background seroprevalence.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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