Risk based HIV retesting: back to the same old challenges.

An estimated 230,000 Americans are unaware that they have HIV infection. As a result, these individuals have not benefited from treatment for HIV infection and they may continue to spread the disease. In 2006, the Centers for Disease Control and Prevention (CDC) reported that 40% of adults aged 18-64 had been tested for HIV but only 10% had been tested within the last 12 months. A national survey conducted by the CDC in 2000 found that only about one-quarter of primary care providers and emergency physicians reported routinely testing their patients for HIV. To improve the performance of HIV testing, in 2006 the CDC issued recommendations that patients in all health care settings be offered universal, opt-out HIV testing. Since that time, several studies have demonstrated the feasibility of opt-out testing but barriers to implementation persist. Many states still require signed consent and counseling and other logistical challenges include: insufficient time, competing priorities, and inadequate reimbursement. Therefore, universal HIV testing remains an unrealized goal.