Anonymous HIV testing programs encourage people to get tested earlier and therefore to begin medical treatment earlier, according to a new study led by University of California San Francisco researchers.
Study results appear in the October 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. 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," said principal investigator Andrew Bindman, MD, director of the UCSF Primary Care Research Center at San Francisco General Hospital Medical Center."
"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.
The UCSF study included data on a random sample of 835 persons diagnosed with AIDS between May 1995 and December 1996. All participants had voluntarily sought HIV testing. Working with state health departments, the research team was able to conduct personal interviews with 68 percent of eligible subjects. About 25 percent of study participants had elected anonymous testing (192 in the anonymous group vs. 643 in the confidential group).
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.
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.
Study co-investigators are Dennis Osmond, PhD; Frederick M. Hecht, MD; Karen Vranzian, MA, and Dennis Keane, MPH, all of UCSF; Arthur Reingold, MD, of UC Berkeley; and J. Stan Lehman, MPH, of the Centers for Disease Control and Prevention.
Note To The Media: Reporters who would like to interview Andrew Bindman, MD, study principal investigator, can reach him directly at (415) 206-6095.
Journal
JAMA