Two studies published last week in the New England Journal of Medicine report on the benefits of routine screening for HIV in the general US population. If instituted, routine screening will result in huge public health benefits along with the possibility of eventually eradicating the disease when a vaccine becomes available.

In the US, the Centres for Disease Control and Prevention had previously recommended that routine screening should be carried out in populations with an HIV prevalence of 1% or higher. That recommendation is now considered inadequate and a change of policy is being considered to implement routine screening of the general population. The US currently has an overall HIV prevalence that is less than 1%. South Africa has an estimated HIV prevalence of over 22% making a very strong case for the adoption of these guidelines. Both studies estimate that the gains made from routine screening would come at a reasonable cost. Furthermore, the costs of screening decrease at higher prevalence rates so that the gains made in South Africa would be substantially higher than that calculated for the US population.

HIV infection is generally discovered at an advanced stage, often during care for complications of AIDS. Earlier diagnosis would help to improve on care, slow disease progression and improve on response to medication. The studies show that one-time screening for the general population would reduce the annual rate of HIV infection by more than 20% delivering a huge public health benefit. In addition, the widespread use of HIV screening would be consistent with commonly accepted standards for clinical practice such as routine testing for diabetes or cancer.

Major benefits of routine screening would include a reduction in lost productivity due to HIV infection and the opportunity to influence the course of the epidemic in a significant way. It would also permit better control of other sexually transmitted diseases and help improve on the allocation of resources to treat and prevent HIV. These studies show the need for a strong link between testing for HIV, access to antiretroviral therapy and/or other appropriate care and the use of effective preventive measures. According to the authors, given the availability of effective therapy and preventive measures, it is possible to influence the course of the epidemic through widespread and cost-effective screening.

It is recommended that repeated screening should be considered for high-risk populations, and its value in other populations be reassessed after one-time screening programs have been firmly established. An editor of both studies noted that “failure to implement widespread routine screening for HIV infection represents a critical disservice to patients who are currently infected, those at risk for infection, and the future health of the nation”.

While the complexity of establishing screening programs in South Africa will vary from that of the US, the findings from these studies clearly demonstrate that the potential benefits of universal HIV screening are equally applicable here. For these reasons, Doctors For Life International (DFL) would like to strongly urge the government to establish routine screening for HIV in the general population with repeated screenings for high risk populations.

‘Doctors for Life International’ represents more than 1000 medical doctors and specialists, three-quarters of who practise in South Africa. DFL was founded as a South African organisation in 1991 and has spread across the globe. DFL is involved in several community projects including orphan care, the care of terminal AIDS patients, malaria prevention and the care of abused women.