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TB Elimination

Recommendations for Human Immunodeficiency 

Virus (HIV) Screening in Tuberculosis (TB) Clinics

What are the recommendations for 

human immunodeficiency virus 

(HIV) screening in tuberculosis 

(TB) clinics?

CDC recommends HIV screening for all TB 

patients after the patient is notified that 

testing will be performed, unless the patient 

declines (i.e., opt-out screening). This includes 

persons with TB disease and persons with 

latent TB infection. Routine HIV testing is 

also recommended for persons suspected of 

having TB disease, persons diagnosed with 

latent TB infection, and contacts to TB patients. 

Prevention counseling and separate written 

consent for HIV testing should no longer be 

required. These recommendations are aimed 

at eliminating missed opportunities for HIV 

screening and reducing significant barriers to 

HIV testing in health care settings by:

• Using opt-out HIV screening; 

• Annually screening persons at high risk 

for HIV; 

• Eliminating the need for separate written 

consent for HIV testing; and 

• Eliminating the need for prevention 

counseling as part of routine HIV screening. 

What is opt-out screening?

Opt-out screening is defined as performing 

HIV testing after notifying the patient that 

the test will be performed, and although 

the patient may decline or defer testing, it 

is strongly recommended. Assent is inferred 

unless the patient declines testing. 

Why does CDC recommend that 

TB clinics screen their patients for 

HIV infection?

HIV infection is the most important known risk 

factor for progression from latent TB infection 

to TB disease. Progression to TB disease is 

often rapid among people infected with HIV 

and can be deadly. In addition, TB outbreaks 

can rapidly expand in patient groups infected 

with HIV.

Targeted HIV testing based on provider 

assessment of patient risk behaviors fails to 

identify a substantial number of people who 

are infected with HIV. This is because many 

individuals may not perceive themselves to 

be at risk for HIV or do not disclose their risks. 

Routine HIV testing also reduces the stigma 

associated with testing.

When HIV is diagnosed early, appropriately 

timed interventions can lead to improved 

health outcomes, including slower progression 

and reduced mortality. Identifying TB patients, 

suspects, and contacts infected with HIV 

allows for optimal TB testing of these groups 

and provides opportunities to prevent TB in 

those without disease. 

Who should be tested for HIV in 

TB clinics?

All patients in TB clinics should be tested for 

HIV. This includes persons with TB disease 

or latent TB infection; persons suspected of 

having TB because of signs and symptoms 

of TB; and persons identified as contacts to 

someone with infectious TB disease.
August 2012

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Can rapid HIV tests be used to 

screen TB patients and their 

contacts?

Yes. Rapid HIV tests (http://www.cdc.gov/

hiv/topics/testing/rapid/index.htm), using 

fingerprick or oral specimens, can be used. 

Results are available in about 20 minutes. 

Although the rapid HIV test kits cost more per 

test than standard lab assays, they have been 

shown to be cost-effective and to increase 

patients’ acceptance of HIV testing. Another 

option is to collect oral swab specimens and 

use standard lab assays.

What education and training 

resources on HIV counseling and 

testing are available?

Resources for education and training on 

HIV counseling and testing are available 

from CDC-funded HIV/AIDS programs in 

each state health department, and from the 

National Network of STD/HIV Prevention 

Training Centers (NNPTC) (http://depts.

washington.edu/nnptc/). Additionally, the 

Health Resources and Services Administration 

(HRSA) has regional AIDS Education and 

Training Centers (AETCs) (http://www.aidsetc.

org/aidsetc?page=ab-00-00) and other local 

performance sites that can provide training 

in HIV counseling and testing to TB staff. 

Also available is a Contact Investigation and 

Management Protocol (http://www.nyc.gov/

html/doh/downloads/pdf/tb/tb-manualsection9.pdf) to facilitate HIV counseling, 

testing, and referral during TB contact 

investigations. The protocol was developed 

by the New York City Bureau of TB Control, 

in collaboration with the New York City 

Department of Health HIV Training Institute, 

with funding from CDC. 

For More Information

1. CDC. Revised Recommendations for HIV Testing 

of Adults, Adolescents, and Pregnant Women 

in Health-Care Settings. MMWR 2006; 55 (No. 

RR-14). http://www.cdc.gov/mmwr/preview/

mmwrhtml/rr5514a1.htm

2. CDC. HIV Testing in Health Care Settings. 

http://www.cdc.gov/hiv/topics/testing/

healthcare/index.htm

3. CDC. Rapid HIV Testing. http://www.cdc.gov/

hiv/topics/testing/rapid/index.htm

Resources

• National Network of STD/HIV Prevention 

Training Centers.

http://depts.washington.edu/nnptc

• AIDS Education and Training Centers (AETCs). 

http://www.aidsetc.org/aidsetc?page=ab-00-00

• New York City Bureau of Tuberculosis Control. 

Contact Investigation and Management 

Protocol. http://www.nyc.gov/html/doh/

downloads/pdf/tb/tb-manual-section9.pdf

http://www.cdc.gov/tb