Implementing Routine HIV Screening in Three Chicago Hospitals: Lessons Learned

Abstract

Objective. This study describes routine HIV screening implementation and outcomes in three hospitals in Chicago, Illinois.Methods. Retrospective data from three hospitals were examined, and routine testing procedures, testing volume, reactive test results, and linkage-to-care outcomes were documented.Results. From January 2012 through March 2014, 40,788 HIV tests were administered at the three hospitals: 18,603 (46%) in the emergency department (ED), 7,546 (19%) in the inpatient departments, and 14,639 (36%) in outpatient clinics. The screened patients varied from 1% to 22% of the total eligible patient population across hospitals. A total of 297 patients tested positive for HIV for a seropositivity rate of 0.7%; 129 (43%) were newly diagnosed and 168 (57%) were previously diagnosed, with 64% of those previously diagnosed out of care at the time of screening. The inpatient areas had the highest seropositivity rate (0.6%). The percentage of newly diagnosed patients overall who were linked to care was 77%. Of newly diagnosed patients, 51% had $1 missed opportunity for testing (with a mean of 3.8 visits since 2006), and 30% of patients with missed opportunities were late testers (baseline CD41 counts ,200 cells per cubic millimeter). Conclusion.Routine screening is an essential tool for identifying new infections and patients with known infection who are out of care. Hospitals need to provide HIV screening in inpatient and outpatient settings-not just EDs-to decrease missed opportunities. Routine screening success will be driven by how notification and testing are incorporated into the normal medical flow, the level of leadership buy-in, the ability to conduct quality assurance, and local testing laws.

Evaluation of the Utility of Point-of-Care HIV Testing on a Canadian Internal Medicine Inpatient Unit

“…The low rate of routine HIV testing reflects a high rate of missed opportunities: instances where HIV-infected individuals present to medical care with possible HIV-related illnesses, but who are not tested for HIV. The prevalence of missed opportunities is generally high across various populations [ 14 , 16 – 19 ]. Inpatient units provide a unique opportunity for HIV recognition and linkage to long-term follow-up care.…”

“…Inpatient units provide a unique opportunity for HIV recognition and linkage to long-term follow-up care. A study by Rucker et al conducted at three hospitals in Chicago, Illinois, found that inpatient areas had the highest seroprevalence of undiagnosed HIV (0.6%) compared to emergency room (0.4%) and outpatient care areas (0.1%), highlighting the need to focus on inpatient HIV screening [ 14 ].…”

“…Among several urban tertiary care centres in the United States, the prevalence of undiagnosed HIV on inpatient hospital units is highly variable. This variability appears to be reflective of the study sample size: in the study by Padrnos and colleagues, 283 patients were screened with a reported prevalence of undiagnosed HIV of 0%; Osorio and colleagues screened 1537 patients and reported a prevalence of 0.4%; and finally, the group of Rucker and colleagues screened 7546 patients with a prevalence of 0.6% [ 14 , 25 , 26 ]. Additionally, the failure to identify HIV in an inpatient hospital setting—where a considerable population of patients receive the majority of their medical care—would constitute a critical missed opportunity.…”

“…Several studies examining the use of POC HIV testing in emergency departments of tertiary care centres have found a prevalence of undiagnosed HIV between 0% and 1.4% [ 8 , 11 – 13 ]. Evidence suggests that the prevalence of undiagnosed HIV may be comparable on hospital inpatient wards [ 14 ].…”

Real-world performance of the new US HIV testing algorithm in medical settings

“…There are unique opportunities to test patients who visit the emergency department or urgent care but might not otherwise seek testing [4-7], and hospital-wide routine HIV screening has been shown to be a valuable tool for identifying new infections and preventing missed opportunities to diagnose individuals of unknown status [8,9]. These testing opportunities can be driven by symptoms, which may indicate acute HIV infection [10] or by the patient care situation (e.g., pregnancy) [11,12].…”