Directors' Choice

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Month/Year Paper
Sept. 2017 Osorio G, Hoenigl M, Quartarolo J, Barger K, Morris SR, Reed SL, Lee J, Little SJ. Evaluation of opt-out inpatient HIV screening at an urban teaching hospitalAIDS Care. 2017;29(8):1014-1018. PMCID 5469710.

About This Paper

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 8,488 eligible inpatients, opt-out HIV testing was offered to 3,017 (36%) patients, and rapid antibody testing was performed in 1,389 (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.  

Our study showed, that opt-out inpatient HIV screening was associated with markedly lower per test positivity rates when compared to targeted testing in the ED, and these newly HIV diagnosed patients were not typically tested through physician-directed testing in the ED. 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. To increase the uptake of routine HIV testing more extensive focus, training and support for staff and providers may be required. Future studies should evaluate whether uptake of inpatient HIV screening may be improved when taken out of the hands of physicians who are providing routine care and given into the hand of staff who routinely obtain consent for care.

View other Director's Choice selections from 2017 and  2016.

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