AMA develops toolkit to help providers increase infectious disease screening

Rita K. Kuwahara, MD, MIH

Early detection of HIV, sexually transmitted infections, viral hepatitis and TB is not only important to improve individual clinical outcomes and reduce the risk for complications associated with late-stage disease, but it is also key to preventing further community spread of these infections.

There was a significant reduction in routine screenings associated with the start of the COVID-19 pandemic, and it is essential that we increase these screenings to ensure that every person eligible for screenings under current guidelines receive their recommended testing as an issue of health equity.

For busy clinicians, automated electronic health record prompts, standing orders and other streamlined processes to facilitate recommended screenings are central to increasing the rates of recommended screenings, and the AMA initiative to develop a toolkit to improve screening rates addresses an important need.

Further, community health centers serve diverse populations and play a central role in providing preventive health services, including routine screenings and vaccinations, so it is commendable that the AMA is collaborating with select community health centers to pilot its newly developed toolkit to improve recommended screenings

As this toolkit and other strategies to increase routine screenings are implemented, it is important to avoid adopting a siloed approach, and rather to invest in building an infrastructure capable of adapting to an evolving public health landscape.

For example, while creating simple approaches to allow clinicians to integrate recommended screenings for HIV, STIs, viral hepatitis and TB into daily clinical practice, systems should be in place to expand infectious disease screenings if needed to address new outbreaks and emerging infectious diseases, so that, in the future, we can rapidly get ahead of diseases such as COVID-19 and monkeypox.

From a patient perspective, early detection of infectious diseases will enable patients to receive treatment for their diagnosed infection as soon as possible, allowing them to receive any available curative or maintenance treatments and appropriate linkages to care if periodic monitoring is required for chronic infections. From a public health perspective, rapid diagnosis of infectious diseases is crucial for identifying, tracking and containing any potential infectious disease outbreaks in a community.

In addition, ensuring equitable access to preventive services is critical, and efforts must be made to convey information on recommended screenings in a patient’s preferred language using culturally competent approaches to reduce racial and ethnic health disparities.

Most importantly, if vaccines exist to prevent diseases that are being screened for, systems should be in place to ensure that patients who do not have the disease but also are not immune to the disease receive recommended vaccines to prevent infection.

As an example, since hepatitis B vaccines are now universally recommended for adults aged 19 to 59 years and those aged 60 years and older with risk factors, if a person tests negative for HBV and is susceptible to infection, systems should be in place to ensure that person receives the HBV vaccine to prevent future infection.

Lastly, from a policy perspective, as strategies are developed to improve routine screenings, it is critical that every person has access to affordable preventive care, including recommended screenings and vaccines. We must ensure that patients with Affordable Care Act health insurance plans continue to have access to recommended preventive services without patient cost sharing, which is a provision currently being challenged by Kelley v. Becerra, the latest lawsuit threatening the ACA.

In addition, when testing for infectious diseases such as HIV, HBV and hepatitis C, it is important that if a patient receives a positive test, they have access to affordable curative medicines for HCV and maintenance medicines and necessary follow-up monitoring for HIV and HBV.

Further, when the CDC updates screening recommendations, as it is currently in the process of doing for HBV screening, if the CDC’s updated recommendations do not align with current U.S. Preventive Services Task Force recommendations, patients with ACA health insurance plans would not be eligible to receive the CDC recommended screening without patient cost-sharing, unless the USPSTF subsequently updated its recommendations.

As a result, it is important for the USPSTF to prioritize reevaluating any guidelines recently updated by the CDC to allow widespread implementation of recommendations in clinical practice and prevent patients from having to pay unexpectedly high medical bills for screenings not covered by insurance.

Nationwide, as we have seen widening health disparities and initial declines in routine screenings during the COVID-19 pandemic, strategies and toolkits such as the one developed by the AMA must be implemented to equip clinicians with the tools to effortlessly integrate recommended routine screenings and vaccines into their daily clinical practice to reduce inequities and improve patient and community health outcomes.