Background:  HIV counseling and testing (C&T) programs in resource-limited settings diagnose HIV infection, reduce risk behavior, and refer individuals to follow-up HIV care services. Routine HIV C&T for all patients visiting high-prevalence health care units has been proposed to increase access to testing by infected individuals, many of whom may be in urgent need of care. We tested the acceptability of routine HIV C&T to in-patients at an urban hospital in Uganda.

Methods:  Data was collected in a randomized controlled trial of routine in-patient HIV C&T vs referral for ambulatory HIV C&T 1 week post discharge (standard of care). Participants with previously undocumented HIV serostatus were sampled randomly from adult in-patients on medical wards at Mulago hospital. Following consent and randomization, a baseline structured interview that included assessment of HIV risk behavior patterns was administered. Recruitment was conducted from March to September 2004. Follow up is ongoing.

Results:  Among the 590 eligible individuals who were approached, 500 (85%) agreed to participate and were recruited into the study. All participants randomized to the in-patient C&T arm were counseled, tested, and given their results before discharge. Several months after discharge, only 104 (42%) of those randomized to ambulatory C&T have returned for testing. Overall HIV prevalence among those who have tested in the study to date (354) was 58%. Among the 21- to 40-year age group, 68% were HIV-positive. Overall, 341 (68%) participants reported sexual intercourse during the 12 months prior to study enrollment, 62% in the preceding six months. Sixty (12%) reported more than one sexual partner in the last 6 months. Condom use with last sexual partner in the previous 6 months was low: 205 (70%) never used; 62 (21%) used sometimes; and 27 (9%) used consistently. Sixteen participants reported sexual intercourse with casual partners in the previous six months.

Conclusions:  We found routine in-patient HIV C&T to be highly acceptable in the medical in-patient setting of an urban sub-Saharan African hospital. Despite acute illnesses that may often be markers of advanced HIV disease, there was significant ongoing HIV risk behavior among medical in-patients. Referral of hospitalized patients for HIV C&T post discharge is a missed opportunity for HIV diagnosis, prevention counseling, and linkage to care.

Keywords: Routine HIV counseling and testing; HIV prevalence; HIV risk behavior