Published November 17, 2020
Primary care and prevention experts reviewed the literature to provide you the most up-to-date recommendations for clinical preventive services. The 2020 USPSTF recommendations are presented here in order of the greatest net benefit.
Grade B recommendations: There is high certainty that the benefit is moderate or there is certainty that the benefit is moderate to substantial. Clinicians should offer or provide the following services.
1. Sexually Transmitted Infections: Behavioral Counseling
Sexually transmitted infections are a burden on the health care system and effective behavioral counseling reduces the spread of these infections for at least one year. Similar to the 2014 recommendation, the USPSTF recommends that all adolescents and adults who are at risk for sexually transmitted infections be offered behavioral counseling to prevent further spread of disease.
This applies to sexually active adolescents and adults who:
- have had a sexually transmitted infection within the past year
- have unprotected sex
- have multiple sexual partners
- belong to a high-risk group, including people with HIV, sex or gender minorities, use intravenous drugs, exchange sex for money, or have recently been incarcerated
Counseling should be done in person, patients should be referred to a counseling center, or they should be given media-based interventions. The most effective counseling interventions include those that are done in large groups, that last at least 120 minutes, or that are offered in multiple sessions. Symptoms and transmission of common sexually transmitted infections should be addressed. Additionally, safer sex practices should be taught and condom use should be demonstrated.
2. Unhealthy Drug Use: Screening
Unhealthy drug use is a common cause of morbidity in the United States and screening allows physicians to offer appropriate treatment services that reduce unhealthy drug use. The USPSTF recommends that adults age 18 years and older have regular screenings to evaluate for illegal and inappropriate prescription drug use. The benefits of screening have not been shown to outweigh the risks in adolescents under age 18.
Screening for illicit drug use entails asking the patient about the use either in person or through the utilization of screening tools such as the National Institute on Drug Abuse Quick Screen. It does not mean performing laboratory-based testing. Screening should only be done if the physician can provide further care or offer referrals for adequate diagnosis, treatment, and care.
3. Prevention and Cessation of Tobacco Use in Children and Adolescents: Primary Care Interventions
Tobacco use continues to be the leading cause of preventable death in the United States and the use of e-cigarettes has surpassed regular cigarette use in adolescents. Similar to the 2013 recommendation, the USPSTF recommends that clinicians provide interventions in the form of education and brief counseling to school-age children and adolescents to prevent the initiation of tobacco use including the use of e-cigarettes. There is insufficient evidence to assess the benefits and risks in providing interventions for the cessation of tobacco use amongst those who already use tobacco.
Clinicians should ask school-age children and adolescents whether they are using tobacco. If they are not using tobacco then behavioral counseling should be provided in face-to-face interactions, telephone conversations, or print-based materials.
4. Hepatitis C Virus Infection in Adolescents and Adults: Screening
All adults age 18–79 years should be screened for hepatitis C virus (HCV) infection. This recommendation has been updated to include all adults instead of only a birth cohort and high-risk individuals.
Patients should be screened with anti-HCV antibody testing followed by confirmatory PCR testing. Screening should be done voluntarily, and patients should be informed about HCV infection, transmission, the meaning of their test results, and the benefits and harms of treatment. New evidence shows that direct-acting antiviral agents have a much higher average cure rate for patients with HCV. Therefore, adults with a positive screening test should have continued diagnostic evaluation and be treated with direct-acting antiviral agents for 8–12 weeks.
Grade D recommendations: There is moderate or high certainty that the service has no benefit and the harms outweigh the benefits. Clinicians should discourage the use of the following service.
1. Bacterial Vaginosis in Pregnant Persons to Prevent Preterm Delivery: Screening
Similar to the 2008 recommendation, the USPSTF recommends against screening for bacterial vaginosis in asymptomatic pregnant people. There is insufficient evidence to assess the benefits versus harms of screening for bacterial vaginosis in pregnant people who are already at increased risk for preterm delivery.
Bacterial vaginosis is a common infection of the lower genital tract and research suggests that it is a risk factor for preterm delivery. However, the accuracy of screening tests for bacterial vaginosis varies and there is no evidence to suggest a difference in the incidence of preterm delivery and its related outcomes after treatment for asymptomatic bacterial vaginosis in pregnant patients.
Grade I recommendations: The current evidence is insufficient to assess the benefits and harms of the service. If the following services are offered, patients should be told about the uncertainty of the benefits and harms.
1. Cognitive Impairment in Older Adults: Screening
In asymptomatic adults, 65 years and older, the USPSTF has not found sufficient evidence to balance the benefits and harms of cognitive impairment screening. This recommendation does not apply to persons who are hospitalized or living in institutions such as nursing homes. Clinicians should remain alert to signs and symptoms of cognitive decline, but formal screening is not recommended.
2. Illicit Drug Use in Children, Adolescents, and Young Adults: Primary Care-Based Interventions
Similar to the 2014 recommendation, the USPSTF does not find sufficient evidence to balance the benefits and harms of providing behavioral counseling and interventions to prevent illicit drug use in children, adolescents, and young adults. This recommendation does not apply to persons who already have a history of harmful illicit drug use or who have been diagnosed with a substance use disorder. Clinicians should remain alert to the signs of illicit drug use and treat the problem as deemed necessary.
References
Henderson JT, Senger CA, Henninger M, Bean SI, Redmond N, O’Connor EA. Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;324(7):682–699. doi:10.1001/jama.2020.10371
Patnode CD, Perdue LA, Rushkin M, et al. Screening for Unhealthy Drug Use: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;323(22):2310–2328. doi:10.1001/jama.2019.21381
Selph S, Patnode C, Bailey SR, Pappas M, Stoner R, Chou R. Primary Care–Relevant Interventions for Tobacco and Nicotine Use Prevention and Cessation in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;323(16):1599–1608. doi:10.1001/jama.2020.3332
Chou R, Dana T, Fu R, et al. Screening for Hepatitis C Virus Infection in Adolescents and Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;323(10):976–991. doi:10.1001/jama.2019.20788
Kahwati LC, Clark R, Berkman N, et al. Screening for Bacterial Vaginosis in Pregnant Adolescents and Women to Prevent Preterm Delivery: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;323(13):1293–1309. doi:10.1001/jama.2020.0233
Patnode CD, Perdue LA, Rossom RC, et al. Screening for Cognitive Impairment in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;323(8):764–785. doi:10.1001/jama.2019.22258
O’Connor E, Thomas R, Senger CA, Perdue L, Robalino S, Patnode C. Interventions to Prevent Illicit and Nonmedical Drug Use in Children, Adolescents, and Young Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;323(20):2067–2079. doi:10.1001/jama.2020.1432