Screening for HIV: US Preventive Services Task Force Recommendation Statement
US Preventive Services Task Force
This guideline focuses on screening for HIV in adolescents, adults and pregnant women1.
At the end of 2009, the number of people with HIV in the United States who were aged 13 years and older was an estimated 1,148,2002, representing a prevalence of 0.45%. In Canada, the number of people with HIV (including AIDS) was an estimated 71,300 in 20113, representing a prevalence of 0.21%. Similarly, the incidence rate in the United States is nearly twice that of Canada (19.0 vs. 9.9 per 100,000 in 20094 5). Although the proportion of undiagnosed cases is higher in Canada than in the United States (25%3 vs. 18%6), over 50% of some populations in the United States are likely to be unaware of their HIV infection7.
The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen all adolescents and adults aged 15 to 65 years for HIV infection. Younger adolescents and older adults who are at increased risk should also be screened.
In addition, the USPSTF recommends that clinicians screen all pregnant women for HIV, including those presenting in labour who have not been tested and whose HIV status is unknown.
RELEVANCE TO CTFPHC MANDATE
All sections of this guideline are applicable to the CTFPHC mandate of prevention in primary care.
The target populations for screening are adolescents and adults aged 15 to 65 years, younger adolescents and older adults at increased risk for infection, and pregnant women.
EVIDENCE REVIEW METHODS
The USPSTF searched Ovid MEDLINE for the period 2004 to June 2012 and the Cochrane Library through the second quarter of 2012, and reviewed reference lists to identify relevant articles published in English. The search for evidence relevant to adults and adolescents resulted in a total of 10,297 abstracts; 876 full-text articles were reviewed for relevance, of which 25 were included in the evidence synthesis. The search for evidence relevant to pregnant women resulted in a total of 1,636 abstracts; 387 full-text articles were reviewed for relevance, of which 38 studies from 43 publications were included in the evidence synthesis.
The USPSTF assigns 1 of 5 letter grades to each recommendation: A, B, C, D, or I8. These grades are based largely on the level of certainty and magnitude of the net benefit associated with providing the service. For more information on the grading scheme, see Table 2 and Table 3.
The CTFPHC assessed the methodological quality of this guideline using the Appraisal of Guidelines Research & Evaluation (AGREE II) criteria (Table 1).
This guideline scored above 60% on the domains of Scope and Purpose, Rigour of Development, and Editorial Independence; therefore, the CTFPHC has classified it as a high-quality guideline. Concordance among reviewers, as measured through standard deviation (SD) of AGREE II scores, was high (SD < 1.5) for the majority of domains.
|AGREE II domain||Domain score||Standard deviation|
|Scope and purpose||93%||0.8|
|Rigour of development||88%||0.8|
|Clarity of development||90%||0.8|