1st appeared 28 October 1998

Anonymous HIV Testing Linked to Earlier Medical Treatment

Anonymous HIV testing programs encourage people to get tested earlier and therefore to begin medical treatment earlier, according to a new study led by UCSF researchers.

Study results appear in today's (Oct. 28) issue of The Journal of the American Medical Association (JAMA).

"HIV is the only infectious disease with dedicated anonymous testing programs that are funded by public health departments, and this practice has been controversial," said principal investigator Andrew Bindman, director of the UCSF Primary Care Research Center at San Francisco General Hospital Medical Center. "We wanted to find out if this strategy worked to get people at risk for HIV infection to come in earlier for testing and care.

"Our study findings show two important outcomes. Anonymous testing is associated with earlier diagnosis of HIV infection, which means persons who know they are HIV positive can take steps to control the spread of the virus, and to earlier follow-up treatment, which can significantly impact quality and length of life," he added.

The research team compared the two types of HIV testing -- confidential and anonymous -- in seven states: Arizona, Colorado, Missouri, New Mexico, North Carolina, Oregon and Texas. In confidential testing, a person's name is linked to the specimen and test results are recorded in a medical chart with the name. The chart is handled according to standard confidentiality guidelines for medical records.

In anonymous testing, a unique identifying label (usually a number) rather then a patient's name is used to link the specimen and the result to the patient. The result is not recorded in a medical chart that has a patient name. The anonymous testing procedure was developed because of the stigma of AIDS in the early days of the epidemic and concerns that there would be breaches in the confidentiality of the medical chart.

At present, 40 states have publicly funded anonymous testing programs for HIV. This type of testing program is available even in many of the states that require HIV named reporting, a public health program that is designed to facilitate surveillance of the HIV epidemic. Individuals who test anonymously for HIV in named reporting states are not reported to the public health department until after they present for HIV-related medical care, at which point their names are linked with their test results.

Several studies looking at the value of anonymous testing previously have been conducted, but the samples were small and usually limited to one state and the results varied, Bindman said.

Study findings showed:

• Persons who underwent anonymous HIV testing tended to be in an earlier stage of HIV disease. In this group, the average time from learning of one's HIV positive status to being diagnosed with AIDS was about a year-and-a-half longer than for those in the confidential group (1,247 days vs. 718 days).
• The period of HIV-related medical care between time of HIV-positive diagnosis and AIDS diagnosis was much greater for persons in the anonymous group (918 days) than for those in the confidential group (531 days).
• As a further indication that those in the anonymous testing group were presenting earlier for care, their average first CD4 count (427) was higher than that of those testing confidentially (267). CD-4 cells coordinate the overall action of the human immune system. They are the primary target of HIV and would tend to decrease as HIV disease progresses.
• Persons who tested anonymously vs. confidentially tended to be younger, white, slightly more educated, and more likely to be at risk for HIV because they were men who have sex with men. After adjusting for differences in the characteristics of persons who tested anonymously versus confidentially, anonymous testing remained significantly associated with earlier entry to medical care.

One surprise, the researchers noted, was that neither health insurance nor having a regular source of medical care was associated with early HIV testing or HIV-related treatment.

This suggests, they said, that either patients who have these options pursue HIV testing at the same rate as all at-risk individuals or that physicians are not adequately identifying high-risk patients and encouraging them to undergo early testing.

Bindman also noted that as more states adopt HIV named reporting policies the interest in the option of anonymous HIV testing may grow. Based on their study results, the researchers concluded that public health departments should continue to offer anonymous HIV testing and in some cases even enhance availability.

Links:

Journal of the American Medical Association

Source: Corinna Kaarlela, News Services

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