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

ABSTRACT

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.

KEYWORDS:

• HIV testing
• routine
• HIV surveillance
• emergency department
• healthcare setting

Acknowledgements

We thank Joanne Santangelo, Tari Gilbert, and DeeDee Pacheco for their contributions for the study implementation, data collection, and specimen processing.

Disclosure statement

Dr. Hoenigl served on the speakers’ bureau of Merck. Dr. Little reported grant funding from Gilead Sciences, Inc. No potential conflict of interest was reported by all the authors.

ORCID

Martin Hoenigl http://orcid.org/0000-0002-1653-2824

Additional information

Funding

This work was supported by the Interdisciplinary Research Fellowship in NeuroAIDS, under [grant number R25-MH081482]; the California HIV Research Program under [grant number RN07-SD-702]; and the National Institutes of Health under [grant numbers AI106039], [grant number AI036214], [grant number DA026306], [grant number AI043638], [grant number AI074621] (and AI074621-02S), [grant number AI108351], [grant number MH100974], [grant number MH083552], [grant number AI077304], [grant number AI69432], [grant number MH62512], [grant number AI27670], [grant number AI38858], [grant number AI43752], [grant number AI047745], [grant number NS51132], [grant number AI36214], [grant number AI29164], [grant number AI47745], and [grant number AI57167]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.