Acceptability, feasibility and costs of universal offer of rapid point of care testing for HIV in an acute admissions unit: results of the RAPID project

Abstract

ObjectivesUK guidance recommends that acute medical admissions are offered an HIV test. Our aim was to determine whether a dedicated staff member using a multimedia tool, a model found effective in the USA, is an acceptable, feasible, and cost-effective model when translated to a UK setting. MethodsOver 4 months in 2010, a health advisor (HA) approached 19-65-year-olds at a central London acute medical admissions unit and offered a rapid HIV point of care test (POCT) with the aid of an educational video. Feasibility and acceptability were assessed through surveys and uptake rates. Costs per case of HIV infection identified were established. ResultsOf the 606 eligible people admitted during the pilot, 324 (53.5%) could not be approached or were individuals for whom testing was deemed inappropriate. In total, 23.0% of eligible admissions had an HIV POCT. Of the patients who watched the video and had not recently been tested for HIV, 93.6% (131 of 140) agreed to an HIV test; four further patients had an HIV test but did not watch the video. Three tests (2.2%; three of 135) were reactive and all were confirmed HIV positive on laboratory testing. HIV testing in this setting was felt to be appropriate by 97.5% of individuals. The cost per patient was £21, and the cost per case of HIV identified was £1083. ConclusionsUniversal POCT HIV testing in an acute medical setting, facilitated by an educational video and dedicated staff, appears acceptable, feasible, effective, and low cost. These findings support the recommendation of HIV testing for all medical admissions in high-prevalence settings, although with this model a significant proportion remained untested.

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

“…There were two educational interventions targeting patients; one for pregnant women , which resulted in an increase in testing coverage (from 87 to 92%) after provision of a patient information leaflet and one for patients admitted to a hospital inpatient unit, where there was a decline in test offer (from 8 to 0%) . All four communication technology studies were directed to patients, with two providing videos on HIV testing , one utilizing text messages to recall MSM for testing and one using online platforms for partner notification . The only study measuring intervention impact reported an increase in the re‐testing rate among MSM who were actively recalled (from 19 to 44%) .…”

“…Novel HIV testing technologies were employed by 40 studies in a wide range of clinical settings to increase testing coverage; the majority utilized rapid testing (n = 36) [18,19,22,24,25,34,36,45,46,[48][49][50]56,57,59,65,75,77,81,83,85,88,89,[99][100][101]107,113,117,129,132,134,137,139,141] while four utilized self-sampling (n = 3) [44,52,102] and self-testing strategies (n = 1) [108]. Two of the four self-sampling studies used oral fluid sampling while the self-test required a blood sample.…”

The late‐presenting HIV‐infected patient 30 years after the introduction of HIV testing: spectrum of opportunistic diseases and missed opportunities for early diagnosis

“…Availability of counselling or a pathway to refer discharged patients for outside counselling and testing should be routinely provided in all emergency departments in order to detect HIV infection early . If available, an acute admissions unit could provide timely in‐house testing without the use of extra resources , but a recent UK audit showed inadequate testing even after introduction of simplified guidelines, particularly in patients with shorter hospital stays and in patients not seen by an infectious disease specialist .…”

Increased HIV testing among hospitalized patients who declined testing in the emergency department

“…Patient attitudes about and willingness to go undergo HIV testing vary among populations, settings, and testing strategies (Burns et al, 2013; Christopoulos et al, 2012; Cunningham et al, 2009; Goetz et al, 2008; Jain et al, 2008; Lin et al, 2014; Merchant et al, 2008). The majority of studies reporting on these attitudes and behaviors use cross-sectional designs that do not account for the serial nature of how individual patients interact with health-care systems.…”

“…Variable rates of testing across different care settings, including the Emergency Department (ED), inpatient, and outpatient settings, suggest that some patients may be more likely to test in one setting over another (Burns et al, 2013; Cunningham et al, 2009; Goetz et al, 2008; Jain et al, 2008; Lin et al, 2014; Merchant et al, 2008). Health-care systems have serial encounters with the same patients across these care settings; however, few studies have examined the role of reoffering HIV testing after a patient declines.…”