Background:  In anticipation of the revised Centers for Disease Control and Prevention (CDC) HIV screening recommendations, Bellevue Hospital initiated a multi-disciplinary pilot project in early January 2006 to test all inpatients for HIV in the Department of Medicine service, regardless of risk. 

Methods:  Rapid HIV testing (RHT) using the  whole blood Ora-Quick method was implemented in 3 separate testing areas:  ambulatory care for general medicine (AMCARE), inpatient medicine (MED), and in the emergency room (ER). Point-of-care testing via fingerstick was used in AMCARE and ER, whereas blood by venipuncture was obtained on MED. Initial data showed that testing all patients, regardless of risk, was more difficult than originally thought. As a result, we designed a short questionnaire for house staff to assess the barriers to consenting patients on the inpatient wards. The questionnaire contained 3 sections. The first section included questions that obtained demographic information. The second section specifically asked house staff to evaluate the following potential barriers to consenting their patients:  time, patient knowledge, house staff’s knowledge, patient’s language, patient’s cultural background, fear of inadequate follow-up, not knowing the protocol of the new rapid testing system. The third section included 12 true-or-false knowledge-based questions.

Results:  From January to August 2006, a total of 300, 837, and 588 unique patients underwent rapid HIV testing in MED, ER, and AMCARE, respectively. In MED, 23 (7.7%) were positive, of whom 11 (3.7%) were newly HIV diagnosed. In ER, 24 (2.9%) were positive, of whom 15 (1.8%) were newly diagnosed. In AMCARE, 2 (<1%) were positive, both newly diagnosed. The self-assessment revealed that house staff believe the biggest barrier to consent was time. It also showed that physicians are not trained to routinely ask about a patient’s HIV status nor are they prepared to ask questions about behaviors that may place a person at risk for contracting HIV.

Conclusions:  Our results support the universal testing of all patients in MED and ER.  One of the unexpected outcomes was re-identifying HIV⁺ patients who were lost to follow-up and reintegrating them into care. The change in CDC recommendations will not be easy to implement. Routine testing has the potential to de-stigmatize the disease, while at the same time identifying a larger number of patients who will benefit from the treatment.