Implementing Routine Rapid HIV Testing in a Large Public Healthcare Facility
R Smerd1, E Pearlman1, M Hyde2, D Rakower2, and Judith Aberg*1
1New York Univ at Bellevue Hosp Ctr, New York, US and 2Bellevue Hosp Ctr, New York City Hlth and Hosp Corp, NY, US
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 staffís
knowledge, patientís language, patientís 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 patientís 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.