HIV Testing Reimbursement Sign-On Letter

HIV Testing Reimbursement Subcommittee
of the HIV Health Care Access Working Group
(Affiliated with the Federal AIDS Policy Partnership)

December 17, 2012

Dr. Robert Cosby
c/o USPSTF
540 Gaither Road
Rockville, MD 20850

Dear Dr. Cosby:

The HIV Testing Reimbursement Subcommittee of the HIV Health Care Access Working Group, affiliated with the Federal AIDS Policy Partnership, and the undersigned organizations and individuals, praise the United States Preventive Services Task Force (USPSTF) for strongly recommending that all adolescents and adults from the age of 15 to 65 and pregnant women should be screened for HIV infection.   We fully support the grade “A” recommendation and urge you to finalize it as soon as possible.   This grade change will help make HIV screening a routine part of preventative care. 

Your decision to change the grade for routine testing is supported by scientific evidence and is a critical step in addressing HIV in the United States. There are currently over 1.1 million people living with HIV in the US, but over 200,000 of them are unaware of their infection. Additionally, there continues to be approximately 50,000 new infections each year and more people than ever before are living with the disease.

Using a risk-based testing strategy has proven inadequate because risk can be difficult to determine. Therefore, in order to reduce the number of new infections, we must institute routine HIV testing. 

Making sure that all those living with HIV are aware of their infection is critical to both individual and public health outcomes and to ending AIDS in the U.S.

Diagnosing people early and linking them to care and treatment is the best strategy for improving individual health and clinical outcomes. Federal HIV treatment guidelines now recommend that all individuals with HIV be offered HIV treatment upon diagnosis to improve health outcomes and prevent irreparable disease progression. However, nearly 40 percent of people diagnosed with HIV progress to AIDS within one year of diagnosis, meaning that they have carried the virus for many years without detection. Routinizing HIV screening will help change this.

According to recent studies over 50 percent of new infections are attributable to the 20 percent of people who are unaware of their status. Reversing this trend is critical because we know that when an individual is aware that they are HIV positive, they are more likely to take steps to avoid transmitting the virus to others.

Additionally, the ground breaking study HPTN052 substantiated that HIV treatment can prevent transmission. That is, when someone is diagnosed with HIV, engaged in care, adherent to an antiretroviral regimen, and achieve viral suppression, they are up to 96 percent less likely to transmit HIV. However, in order to realize this benefit, people who are HIV positive must be made aware of their infection through HIV testing and subsequently linked to quality care.

We strongly support the USPSTF Grade “A” recommendation for routine HIV screening for adolescents and adults from age 15 through 65, and pregnant women.  This recommendation now more closely aligns with the CDC recommendation and will be instrumental in realizing an end to HIV/AIDS in the United States.

Should you have any questions or comments please feel free to contact Subcommittee Co-Chairs Carl Schmid at cschmid@theaidsinstitute.org or Holly Kilness at holly@aahivm.org.  Thank you very much.

Sincerely,