Chapter 8.C.2 (6.C.2)  Testing and Public Health

Notes: Testing Programs (page 923/633)

Note 1. Voluntary Screening (page 923/633)

For a recent article on best practices for molecular genetic testing, see Bin Chen et al., Good Laboratory Practices for Molecular Genetic Testing for Heritable Diseases and Conditions, 58 MMWR 1 (2009).  The paper sets out a number of guidelines designed to improve the quality of test delivery and results, as well as outcomes for patients and their families.

For more information on newborn screening, see Public Health Laboratories and Newborn Screening, http://www.aphl.org/aphlprograms/nsg/pages/publichealthlaboratoriesandnewbornscreening.aspx; and National Newborn Screening & Genetics Resource Center, http://genes-r-us.uthscsa.edu/.

Note 4. Medical Testing in Private and Public Employment (page 925/page 634).

Recent litigation focused on HIV screening by the federal government in its role as an employer.  Taylor v. Rice, 451 F.3d 898 (D.C. Cir. 2006). Lorenzo Taylor was refused employment by the U.S. foreign service. Taylor sued the U.S. Secretary of State, claiming that he was discriminated against because of his HIV-positive status.  The Secretary argued that Taylor would “pose a direct threat to himself” if employed by the Foreign Service, as 65% of the posts are “hardship” posts:  foreign locations where “factors such as climate, quality of local health care, and pollution levels render living conditions more arduous than in the United States”. The U.S. District Court for the District of Columbia granted the State Department’s motion for summary judgment.  The D.C. Court of Appeals reversed and remanded for further proceedings.  Taylor v. Rice, 451 F.3d 898 (D.C. Cir. 2006).

In 2008, two weeks before the trial in Taylor v. Rice was set to begin, new State Department guidelines were issued.  The new guidelines replaced the blanket ban on HIV-positive applicants to the Foreign Service with a case-by-case assessment process.  Shortly after the new guidelines were released, Taylor settled his lawsuit with the Secretary of State.  See Lambda Legal:  After Five-Year Legal Lawsuit, Foreign Service Drops Blanket Ban on Hiring People Living With HIV, http://www.lambdalegal.org/news/pr/foreign-service-drops-ban-on-hiv.html.

Note 5. Mandatory Screening (page 925/635).

        To learn more about the HIV testing laws and policies that have been put in place (or are pending) in each U.S. state, see NCCC:  National HIV/AIDS Clinicians’ Consultation Centre, Compendium of State HIV Testing Laws – 2009, http://www.nccc.ucsf.edu/StateLaws/Index.html.

Problem: Routine HIV Screening for All (page 928/638).

For articles discussing the implementation of the CDC’s recommendations regarding routine HIV screening, see Leslie E. Wolf, Alexis Donoghoe, and Tim Lanem Implementing Routine Testing:  The Role of State Law, 2(10) PLoS One 1005 (2007) (considering the potential impact of routine HIV screening on state requirements relating to pretest counseling and informed consent); A.P. Mahajan et al., Consistency of State Statutes With the Center for Disease Control and Prevention HIV Testing Recommendations for Health Care Settings, 150 Ann Intern Med. 263 (2009).