Recurring pneumonia with repeated hospitalizations. Fever and fatigue. A persistent rash.

Could the cause of these symptoms be an undiagnosed HIV infection? Possibly. Data show that testing more people for HIV may be instrumental in reducing inpatient readmissions, treating HIV before it becomes full-blown AIDS, reducing health inequity, and lowering overall health care costs.

As with any medical test, cost is a factor. When it comes to diagnosing HIV, the tests are relatively inexpensive, easy to administer and quick to deliver results. To assist hospitals, the Health Research & Educational Trust, an affiliate of the American Hospital Association, has produced a free downloadable toolkit on HIV testing and screening costs and reimbursement. The package of tools, available at www.hret.org/hiv-cost, helps providers that want to start or expand a routine HIV-screening or diagnostic-testing program.

Prevalence of Late or Unknown HIV Diagnoses

According to the Centers for Disease Control and Prevention, approximately 1 in 5 of the 1.1 million people in the United States who are infected with HIV are unaware of their status. Many HIV diagnoses are made long after the infection has occurred and within months of an AIDS diagnosis. Studies show that late diagnoses may occur after infected patients have had repeated encounters with the health care system — visiting clinics and receiving treatment in emergency departments and inpatient units.

The CDC recommends that everyone ages 13 to 64 be screened for HIV at least once, and that screening take place in all health care settings. Patients at high risk for HIV infection should be screened annually if not more frequently. One of the high-risk factors is living in a community where at least 1 in 1,000 people is infected with HIV. But how many hospitals, physicians and clinics know the HIV prevalence rates of their patient population?

The Case for Routine HIV Screening

Routine screening — that is, performing an HIV test for all persons in a defined population — can assist communities in assessing their HIV-prevalence rates. Besides becoming a standard of care, most notably for expectant mothers, HIV testing is becoming part of routine care, and testing is becoming more accessible. Many states are streamlining their HIV testing processes, no longer requiring separate written informed consent or pre- and posttest counseling. (To view your state's testing requirements, visit http://nccc.ucsf.edu/clinical-resources/hiv-aids-resources/state-hiv-testing-laws/.)

Routine testing helps mitigate the stigma that for too long was associated with being HIV-positive. Studies also show that once HIV-infected individuals learn their status, they change their behaviors and take precautions to reduce the chance of transmitting the virus to others. In addition, with advances in treatment, those who are infected can lead long, otherwise healthy lives and bear healthy, uninfected babies.

Clinic managers may want to screen routinely all patients exhibiting such HIV symptoms as fatigue, sore throat, fever or rash. Or a medical inpatient unit manager may wish to order an HIV test for all patients with pneumonia.

Cost and Reimbursement Toolkit

The HIV Testing and Screening Cost and Reimbursement Toolkit can help estimate monthly test costs and maximize reimbursement potential, based on each provider's payer mix. The toolkit includes:

  • a chart highlighting which payers (public and private) reimburse for testing and screening
  • a cost calculator to estimate expenses and revenue of a testing program
  • a summary of key issues, questions and resources, including:
  • quality improvement ramifications
  • benefits of early diagnosis
  • community benefit potential

The reduction of AIDS-related deaths in the United States often is hailed as a public health success story. However, the data show that diligence should remain a priority, given that an individual is infected with HIV every 9 ½ minutes in this country. The CDC estimates that every year about 200 children in the United States are born infected with HIV, down from 1,650 in the early 1990s. However, in recent years in the United States, some 8,000 HIV-infected women bear children and some 13,000 to 16,000 people with an AIDS diagnosis die annually.

HIV and AIDS statistics in the United States also paint a picture of racial and ethnic inequity. The CDC reports that although 13 percent of the population is black, of the newly diagnosed HIV-infected individuals, 65 percent of the females are black and 45 percent of the males are black. And AIDS is the number one cause of death for African-American women ages 25 to 44.

Whether the goal is to reduce opportunistic infections, mitigate racial inequity, decrease readmissions or lower costs of uncompensated care, the HIV Testing and Screening Cost and Reimbursement Toolkit is a resource that providers can use to improve the health of their communities.

Joan M. Miller, M.H.A., is the executive director of the Association for Healthcare Volunteer Resource Professionals, an AHA affiliate. She previously directed projects on HIV and perinatal prevention for HRET.

For more information on HRET's HIV projects, contact HRET researcher H. Awo Osei-Anto at hanto@aha.org.