Evaluation of opt-out inpatient HIV screening at an urban teaching hospital.

Publisher: Informa Healthcare Country of Publication: England NLM ID: 8915313 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1360-0451 (Electronic) Linking ISSN: 09540121 NLM ISO Abbreviation: AIDS Care Subsets: MEDLINE

Publication: London : Informa Healthcare
Original Publication: Abingdon, Oxfordshire, U.K. : Carfax Pub. Co., c1989-

Emergency Service, Hospital/*statistics & numerical data ; HIV Infections/*diagnosis ; Inpatients/*statistics & numerical data ; Mass Screening/*statistics & numerical data ; Patient Acceptance of Health Care/*statistics & numerical data; Adult ; California/epidemiology ; Female ; HIV Infections/epidemiology ; Hospitals, Teaching ; Humans ; Inpatients/psychology ; Male ; Mass Screening/methods ; Middle Aged ; Patient Acceptance of Health Care/psychology ; Prevalence ; Program Evaluation ; Urban Population

This study evaluated opt-out inpatient HIV screening delivered by admitting physicians, and compared number of HIV tests and diagnoses to signs and symptoms-directed HIV testing (based on physician orders) in the emergency department (ED). The opt-out inpatient HIV screening program was conducted over a one year period in patients who were admitted to the 386-bed University of California San Diego (UCSD) teaching hospital. Numbers of HIV tests and diagnoses were compared to those observed among ED patients who underwent physician-directed HIV testing during the same time period. Survey data were collected from a convenience sample of patients and providers regarding the opt-out testing program. Among 8488 eligible inpatients, opt-out HIV testing was offered to 3017 (36%) patients, and rapid antibody testing was performed in 1389 (16.4%) inpatients, resulting in 6 (0.4% of all tests) newly identified HIV infections (5/6 were admitted through the ED). Among 27,893 ED patients, rapid antibody testing was performed in 88 (0.3%), with 7 (8.0% of all tests) new HIV infections identified. HIV diagnoses in the ED were more likely to be men who have sex with men (MSM) (p = 0.029) and tended to have AIDS-related opportunistic infections (p = 0.103) when compared to HIV diagnoses among inpatients. While 85% of the 150 physicians who completed the survey were aware of the HIV opt-out screening program, 44% of physicians felt that they did not have adequate time to consent patients for the program, and only 30% agreed that a physician is best-suited to consent patients. In conclusion, the yield of opt-out HIV rapid antibody screening in inpatients was comparable to the national HIV prevalence average. However, uptake of screening was markedly limited in this setting where opt-out screening was delivered by physicians during routine care, with limited time resources being the major barrier.

PLoS One. 2012;7(4):e34663. (PMID: 22493708)
Clin Infect Dis. 2016 Feb 15;62(4):501-511. (PMID: 26508512)
J Acquir Immune Defic Syndr. 2016 Apr 15;71(5):551-7. (PMID: 26536321)
AIDS Care. 2016;28(5):591-7. (PMID: 26654431)
PLoS One. 2012;7(6):e39530. (PMID: 22745777)
JAMA. 2010 Jul 21;304(3):284-92. (PMID: 20639562)
Acad Emerg Med. 2013 Mar;20(3):279-86. (PMID: 23517260)
Sci Rep. 2016 May 16;6:25927. (PMID: 27181715)
AIDS. 2016 Jan 2;30(1):151-2. (PMID: 26731759)
AIDS Patient Care STDS. 2008 Aug;22(8):657-62. (PMID: 18721054)
BMC Med. 2015 Sep 11;13:218. (PMID: 26444673)
J Int AIDS Soc. 2014 Nov 02;17(4 Suppl 3):19606. (PMID: 25394110)
Public Health Rep. 2008 Nov-Dec;123 Suppl 3:27-40. (PMID: 19172704)

R01 AI057167 United States AI NIAID NIH HHS; P50 DA026306 United States DA NIDA NIH HHS; R21 AI077304 United States AI NIAID NIH HHS; R01 NS051132 United States NS NINDS NIH HHS; R01 AI047745 United States AI NIAID NIH HHS; UM1 AI069432 United States AI NIAID NIH HHS; R25 MH081482 United States MH NIMH NIH HHS; R01 AI043752 United States AI NIAID NIH HHS; U01 AI027670 United States AI NIAID NIH HHS; R21 AI047745 United States AI NIAID NIH HHS; R37 AI029164 United States AI NIAID NIH HHS; U01 AI069432 United States AI NIAID NIH HHS; R21 AI108351 United States AI NIAID NIH HHS; U01 AI038858 United States AI NIAID NIH HHS; U01 AI043638 United States AI NIAID NIH HHS; R56 AI047745 United States AI NIAID NIH HHS; P30 MH062512 United States MH NIMH NIH HHS; P30 AI036214 United States AI NIAID NIH HHS; R01 MH083552 United States MH NIMH NIH HHS; P01 AI074621 United States AI NIAID NIH HHS; R01 MH100974 United States MH NIMH NIH HHS; R24 AI106039 United States AI NIAID NIH HHS

Keywords: HIV surveillance; HIV testing; emergency department; healthcare setting; routine

Date Created: 20170125 Date Completed: 20171229 Latest Revision: 20191210

20231215

PMC5469710

10.1080/09540121.2017.1282106

28114789