1. Based on this prospective cohort study, targeting HIV screening at high-risk youths performed better than the current standard of universal screening.
2. Individuals who tested negative for HIV infection were more likely to be connected with HIV-prevention programs if engaged through targeted strategies rather than universal screening.
Evidence Rating Level: 2 (Good)
Study Rundown: Nearly half of HIV infected youths in the United States are unaware of their infection status. Current recommendations from the Center for Disease Control (CDC) call for universal screening for HIV in youths 15 years and older. It is uncertain whether universal screening strategies are superior compared to targeted efforts to screen high-risk youth. The current study sought to compare targeted, universal, and combined strategies for HIV screening and the success of referrals to HIV-care and prevention programs. In this study, targeted strategies engaged more sexual minorities and people of color than universal screening practices, and the former had higher rates of HIV diagnosis. Referrals to prevention services were more common if individuals were engaged through targeted testing.
The strengths of this study included its real-world setting and freedom for individual programs to customize strategies to better fit community needs. The main limitations of the study included the lack of data on important measures of efficacy, including the total number of persons engaged by each program, and variable definitions of what constituted successful linkage to HIV-prevention programs.
In-Depth [prospective cohort]: This study included twelve Adolescent Medicine Trials Network for HIV/AIDS Interventions units (AMTUs) that implemented HIV-testing strategies. Strategies could be categorized as either universal screening at clinical settings and school health centers, targeted screening, or a combined approach. Targeted testing involved pop-up testing locations at community-based events, and mobile testing vans. The population of interest included youths aged 13-24 years who identified as sexual minorities as well as those who were persons of color. For 4 of the 5 combined strategy sites, the data was reported in such a way as to allow separate analysis of targeted and universal screening.
Of the 3,301 youths who underwent HIV-screening, 505 were engaged by targeted programs, 962 in universal screening, and 1834 in combined programs. Sexual minorities accounted for 46.7% of targeted program participants, 3.6% of universal screening, and 37.8% of combined programs. Participants who were sexual minorities of color comprised 39.8%, 3.6%, and 27.4% of participants for targeted, universal, and combined programs, respectively. When combined program data was desegregated, targeted testing consisted of 61.8% sexual minorities, 57.4% sexual and ethnic minorities, and 6.3% tested positive for HIV. Universal screening engaged fewer proportions of sexual and ethnic minorities (8.6% and 8.5%) and only 1 individual (0.1%) tested positive for HIV.
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