Background:  It is estimated that 1 in 4 HIV⁺ individuals in the United States is unaware of his or her HIV status. HIV testing protocols, relying on HIV counselors, have remained unchanged for decades. In hospitals, reliance on counselors may present obstacles to broader testing. Rapid HIV testing by physicians with OraQuick was implemented at St Luke’s-Roosevelt Hospital Center in May of 2006 to identify HIV⁺ patients and link them to medical care.

Methods:  All adult patients who present to emergency departments or are admitted to the Inpatient Medical Units of St. Luke’s-Roosevelt Hospital are eligible for testing. Patients also present for rapid testing to the outpatient HIV clinic. Testing is administered by physicians. HIV counselors are available, if needed, to provide post-test counseling for positive tests. All positive tests are confirmed by ELISA and Western Blot. All HIV⁺ patients are referred to Comprehensive Care Center at St. Luke’s-Roosevelt Hospital.

Results:  Overall,  830 tests were administered at emergency departments, inpatient units and outpatient HIV clinics from May of 2006 through the end of August 2006:  33 patients tested positive, 16 of whom were newly positive, according to the patient’s interviews; 17 patients who tested positive reported prior HIV⁺ tests. All HIV⁺ patients have been linked to care. There was a progressive increase in the number of tests performed from the start of the program at all testing venues. The total of 495 rapid tests (230 plasma and 265 oral OraQuick) was performed in the emergency department:  39 in May, 122 in June, 157 in July, and 177 in August; 14 tests were positive (positive rate 2.8%). Of the 14 tests, 6 were newly positive (newly positive rate of 1.2%). The total of 113 rapid tests (all oral) was performed in the outpatient HIV clinic:  19 in June, 37 in July, and 57 in August; 11 tests were positive.  Of the 11 tests, 3 were newly positive HIV tests (newly positive rate of 2.6%). The total of 222 rapid tests (213 plasma and 9 oral OraQuick) was performed on the inpatient unit:  52 in June, 67 in July, and 103 in August. 8 tests were positive. Of the 8 tests, 7 were newly positive tests (newly positive rate of 3.1%).

Conclusions:  Testing by physicians was well received by patients and physicians alike. After 4 months of implementation, we observed a significant increase in the volume of testing.