White Becky L, Carter Yvonne L, Records Katherine, Martin Ian B K
From the Department of Medicine, University of North Carolina at Chapel Hill, the Department of Medicine, Rural Health Group, Roanoke Rapids, North Carolina, and the Center for Health Law & Policy Innovation, Harvard Law School, Jamaica Plain, Massachusetts.
South Med J. 2013 Nov;106(11):637-41. doi: 10.1097/SMJ.0000000000000017.
Eighteen percent of the 1.2 million human immunodeficiency virus (HIV)-infected individuals in the United States are undiagnosed, with North Carolina accounting for the eighth largest number of new HIV diagnoses in 2011. In an effort to identify more HIV-infected individuals by reducing physician barriers to HIV testing, the Centers for Disease Control and Prevention have expanded their HIV screening recommendations to adolescents and adults without HIV risk factors or behaviors, eliminated federal requirements for pretest counseling, and modified the informed consent process. In 2010, the Office of National AIDS (acquired immunodeficiency syndrome) Policy released the first-ever national HIV/AIDS strategy, with the goal of reducing new infections, increasing access to care, improving HIV outcomes, and reducing HIV racial/ethnic disparities. In 2013, the US Preventive Services Task Force released A-level recommendations recommending nonrisk-based HIV screening for adults and adolescents that are consistent with the recommendations of the Centers for Disease Control and Prevention. In concert with these federal recommendations, the majority of states have modified their consent and counseling requirements. The implementation of the Patient Protection and Affordable Care Act will add requirements and incentives for federal (Medicare), state (Medicaid), and private (insurance) payers to reimburse physicians and patients for nonrisk-based HIV screening.
在美国，120万感染人类免疫缺陷病毒（HIV）的个体中有18%未被诊断出来，北卡罗来纳州在2011年新增HIV诊断病例数排名第八。为了通过减少医生对HIV检测的阻碍来识别更多感染HIV的个体，疾病控制和预防中心扩大了对无HIV风险因素或行为的青少年和成年人的HIV筛查建议，取消了联邦对检测前咨询的要求，并修改了知情同意程序。2010年，国家艾滋病（获得性免疫缺陷综合征）政策办公室发布了有史以来的首个国家HIV/艾滋病战略，目标是减少新感染病例、增加获得治疗的机会、改善HIV治疗效果以及减少HIV在种族/族裔方面的差异。2013年，美国预防服务工作组发布了A级建议，建议对成年人和青少年进行基于非风险因素的HIV筛查，这与疾病控制和预防中心的建议一致。与这些联邦建议相一致，大多数州已经修改了他们的同意和咨询要求。《患者保护与平价医疗法案》的实施将增加联邦（医疗保险）、州（医疗补助）和私人（保险）支付方对基于非风险因素的HIV筛查向医生和患者报销的要求和激励措施。
