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Figure. Screening for HIV—analytic framework for screening asymptomatic adolescents and adults. Key Question (KQ) 1: Does screening for HIV infection in asymptomatic adolescents and adults reduce premature death and disability or spread of disease? KQ 2: Can clinical or demographic characteristics (including specific settings) identify subgroups of asymptomatic adolescents and adults at increased risk for HIV compared to the general population? KQ 3: What are the test characteristics of HIV antibody test strategies? KQ 4: What are the harms (including labeling and anxiety) associated with screening? Is screening acceptable to patients? KQ 5: How many newly diagnosed HIV-positive patients meet criteria for antiretroviral treatment or prophylaxis against opportunistic infections? How many patients who meet criteria for interventions receive them? KQ 6: What are the harms associated with the work-up for HIV infection? KQ 7: a) How effective are interventions (antiretroviral treatment, counseling on risky behaviors, immunizations, routine monitoring and follow-up, more frequent Papanicolaou testing, or prophylaxis against opportunistic infections) in improving clinical outcomes (mortality, functional status, quality of life, symptoms, opportunistic infections, or transmission rates)? b) In asymptomatic patients with HIV infection, does immediate antiretroviral treatment result in improvements in clinical outcomes compared to delayed treatment until the patient is symptomatic? c) How well do interventions reduce the rate of viremia, improve CD4 counts, or reduce risky behaviors? KQ 8: What are the harms associated with antiretroviral therapy? KQ 9: Have improvements in intermediate outcomes (CD4 counts, viremia, risky behaviors) been shown to reduce premature death and disability or spread of disease? KQ 10: What is the cost-effectiveness of screening for HIV infection? *Excluding pregnant women, patients undergoing dialysis, and patients receiving transplants. A separate report (13) reviews KQs 6, 7c, 9, and portions of 7a (immunizations, routine monitoring and follow-up, and more frequent Papanicolaou testing).
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