Implementation of Routine HIV Testing in an Acute Care Hospital in Rhode Island: A Nurse-Initiated Opt-Out Pilot Project

Abstract

The Centers for Disease Control and Prevention (CDC) expanded HIV screening of adults ages 13-64 years in 2006 from risk based to routine. Early detection and treatment improve patient outcomes and prevent disease transmission. This article describes a pilot program in which nurses in an adult inpatient unit at an acute care hospital offer HIV testing to all patients ages 18-64 upon admission through standing orders. The pilot, Standing Orders for Routine Testing (SORT), is a response to changes in state law and regulations in the majority of states including Rhode Island, which have occurred following the CDC policy change. The SORT pilot involves collaboration with interdisciplinary partners and education of unit nurses.

The role of nurses in HIV screening in health care facilities: A systematic review

“…In those studies, nurse-driven HIV screening tended to increase test offering, acceptance and delivery rates. The current review showed that nurses were in a unique position to reach a large patient population Costello et al, 2013;Hack et al, 2013;Herbert et al, 2012;Knapp et al, 2011;Leblanc et al, 2012). Nevertheless, only half of the studies (56%) had a control group and 4 studies were RCTs which were single-centre or took place in few centres.…”

“…Only 2 studies, 1 in the United States and 1 in France, analysed the interviews that were conducted with physicians separately from those conducted with nurses. However, Anaya et al (2013) and Costello et al (2013) mentioned that further studies on staff acceptance of nurse-driven HIV screening were under way. Barriers such as staffing, workload and, most likely, the lack of available evidence demonstrating the public health benefits of a routine screening strategy, have hindered its long-term implementation (d' Almeida et al, 2012;McNaghten et al, 2014;White et al, 2009).…”

“…Six studies (20%) specified that nurses disclosed negative results only, whereas physicians delivered positive results Casalino et al, 2012;Costello et al, 2013;Leblanc et al, 2012;Walensky et al, 2011;White et al, 2009). Nurses delivered positive results in one study .…”

“…Nine studies documented organisational barriers, such as insufficient time, legal limitations, lack of knowledge of recommendations and costs Clerk et al, 2013;Costello et al, 2013;d'Almeida et al, 2013;deMarco et al, 2012;McNaghten et al, 2014;Mumma and Suffoletto, 2011;Walensky et al, 2011;White et al, 2009). Additional major barriers for staff members were the concern over delivering a positive test result (Hecht et al, 2011;Leblanc et al, 2012;Thornton et al, 2012) and uneasiness when discussing sensitive topics, such as risk factors, with patients or discomfort with maintaining confidentiality Arbelaez et al, 2012;Chen et al, 2011;Hecht et al, 2011;Kinsler et al, 2013;Rayment et al, 2012;Thornton et al, 2012).…”

Clinical outcomes of routine opt‐out antenatal human immunodeficiency virus screening: a systematic review

“…Unlike the VCT, routine offer is 'provider-initiated' testing and counselling (PITC). Under this model, an HIV test is recommended for all pregnant women, irrespective of level of risk exposure (Costello et al 2013) and test performed as standard group of tests unless explicitly refused by the woman. The lengthy pretest counselling witnessed with VCT is replaced with concise pretest information that meets the minimum standard for informed consent (Revised Recommendations for HIV Testing of Adults, Adolescents, andPregnant Women in Health-Care Settings 2007, Hensen et al 2011).…”