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Universal HIV Screening
Universal HIV Screening: That Means You!

Released: March 23, 2026

Siham Mahgoub
Siham Mahgoub, MD
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Key Takeaways
  • CDC guidance recommends routine, opt-out HIV testing for all people between the ages of 13 and 64 years at least once in their lives.
  • Annual testing is recommended for people with certain risk factors.
  • Universal, status neutral HIV testing should be considered standard preventive care, similar to current screening protocols for diabetes or high cholesterol, to help normalize testing and link to appropriate next steps.

Historically, healthcare professionals (HCPs) believed that HIV testing was only necessary for high-risk patients. However, this misconception is a major contributor to missed or delayed diagnosis. Now, guidelines recommend that HIV testing should be included as part of standard preventive care, the same way primary care providers test patients for diabetes or high cholesterol. This is based on CDC guidance, which recommends that all people should be tested for HIV between the ages of 13 and 64 at least once in their lives. For people with ongoing risk factors, HIV testing should be done annually.

Incorporating HIV Testing into Primary Care
I think it's very important to incorporate status neutral, universal HIV testing in every primary care clinic so we can identify HIV infection early. Status neutral testing is a model focused on joining HIV prevention and treatment efforts such that the whole person is evaluated. The model emphasizes the integration of health services regardless of HIV status. For example, testing when patients are coming in for their annual wellness visit identifies HIV infection early, rather than waiting until a person is presenting to the emergency department with HIV-associated illnesses. This will ensure that all people are linked to appropriate next steps in care, which may include antiretroviral therapy (ART) for those diagnosed with HIV, and prevention tools for those who have negative HIV tests.

Although the advantages of universal testing and early diagnosis are apparent, the “how” of integrating status neutral screening into routine clinical workflows can seem intimidating. I think the best place to start is with educating patients, or at least having educational materials on hand to distribute. Ideally, educational pamphlets would be available in every clinic. Circulation of educational materials is helpful to take away the stigma associated with HIV testing. I find that informing people that HIV is a chronic disease and offering HIV screening as part of routine preventative care goes a long way towards increasing the likelihood that people will get tested.

On the HCP side, we can streamline HIV testing by implementing order sets in the electronic medical record. This makes it easy and efficient for HCPs to order tests. For example, in my practice, there is 1 order set for a routine visit that encompasses a comprehensive panel, including routine blood tests and annual lab work. A status neutral approach to HIV testing would incorporate an HIV test into these routine panels as a default, with an opt-out option available. This way, it's a regular reminder for HCPs that HIV testing can be part of the routine order set, and also creates an opportunity to identify people who may benefit from pre-exposure prophylaxis as part of a status neutral approach.

Closing the Loop With Linkage to Care
Aside from logistics, another barrier that I often see to implementing status neutral HIV testing into primary care is discomfort with discussing a positive HIV test result with patients. Often, additional education on initiating ART and HIV management for primary care providers and trainees can help with gaining confidence in this area.

The first step is learning how to disclose that test result. Here, it is crucial to provide mental health support because patients can view this news as life altering, even though HIV infection is a manageable chronic condition with modern ART. When feasible, results should be disclosed in person to allow for clear explanation of the test results, patient support, and education about HIV as a manageable chronic condition, while initiating rapid linkage to care by an experienced HCP. It is also important to explain that this is a preliminary screening result, as HIV testing follows a stepwise algorithm with confirmatory testing. Explaining to patients that their initial test is positive, but additional testing is needed to confirm the diagnosis, is key for educating patients about next steps.

It is also important that HCPs feel supported when delivering test results. HCPs should have clear resources for referral and understand the process for linking patients to HIV care. For example, at my institution, we have a dedicated phone number to call for linkage to care. So, if patients are newly diagnosed with HIV, their HCPs can call that number to reach a case manager who can assist them with setting this up.

I think the most important aspect of incorporating HIV testing into primary care is ensuring linkage to care. This can be as simple as connecting patients to a case manager or care team, ideally on the same day as their diagnosis, to facilitate timely evaluation and treatment.

Your Thoughts
How can you apply the examples described here towards implementing status neutral HIV testing in your own clinical practice? Leave a comment to join the discussion!

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