Paper # 1051|
Implementation of Opt-out Inpatient HIV Screening at an Urban Teaching Hospital
Georgina Osorio*, J Quartarolo, K Barger, S Morris, S Reed, J Lee, and S Little
Univ of California, San Diego, US
Background: This study evaluated an opt-out HIV
screening program for inpatients at an urban teaching hospital with comparisons
made of patients who underwent HIV testing in the Emergency Department.
Methods: Between October 2008 and October 2009, all
admitted adolescent and adult patients underwent HIV rapid test unless they
declined or were ineligible (admitted to the Obstetrics service or known to be
HIV infected). After verbal consent, HIV testing (OraQuick Advance Rapid
HIV-1/2 Antibody test) on whole blood was performed. Reactive OraQuick rapid
tests were repeated using a second rapid test product (Uni-Gold Recombingen
rapid test) in sequence. Confirmatory labs were performed following preliminary
positive and discordant results. Patients in the Emergency Department underwent
physician directed diagnostic OraQuick rapid HIV testing on whole blood. Characteristics
of patients newly identified with HIV infection by opt-out and physician
directed rapid tests were compared using Fisher Exact and Wilcoxon tests.
Factors associated with accepting testing were analyzed in multivariate
logistic regression. From a convenience subset of individuals, written survey
data was collected from participants and online survey data from providers
regarding the opt-out program.
Results: Of 8488 eligible patients, 1389 (16.4%)
received opt-out inpatient HIV testing; 1480 (21%) opted out of testing. In the
Emergency Department, 87% were eligible to undergo HIV testing, but only 0.32%
completed testing. Of the 1389 inpatients, 6 (0.4%) and of the 88 Emergency
Department patients, 7 (8.0%) of were newly identified with HIV infection. New
HIV diagnoses in the Emergency Department were more likely to be men who have
sex with men (MSM) (p = 0.029), present with HIV-related diagnoses (p
= 0.103), and have lower CD4 cell counts (p = 0.200). In
multivariate analysis, significant predictors of consenting to HIV testing in
the inpatient setting were higher age, black, non-Hispanic race (compared to
white) and admission to Neuropsychiatric Services (compared to Medicine).
Nearly all patients surveyed (96%), noted comfort in being asked by their
physician to undergo opt-out HIV rapid testing, though only 38% of providers
felt that it should be the responsibility of the admitting physician.
Conclusions: Routine HIV testing identified patients
at earlier stages of HIV infection who were less likely to be MSM than
physician-directed rapid testing in the Emergency Department setting. The low
uptake of HIV testing warrants investigation into barriers to HIV testing among
medical providers and patients in both inpatient and Emergency Department