HIV Screening Practices in U.S. Hospitals, 2009–2010

Voetsch, Andrew C.; Heffelfinger, James D.; Yonek, Juliet; Patel, Pragna; Ethridge, Steven F.; Torres, Gretchen Williams; Lampe, Margaret A.; Branson, Bernard M.

doi:10.1177/003335491212700508

Cited by 10 publications

(11 citation statements)

References 45 publications

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“…Based on use of identity-unlinked methodology employed here, we are unable to know whether those individuals were diagnosed or not in our inpatient setting. However, previous studies from our own site and others, suggest shortfalls and opportunities remain [20, 21]. There were some additional observations based on chief complaints, with regard to whether patients with undiagnosed HIV were offered an HIV test or not (i.e.…”

Section: Discussionmentioning

confidence: 94%

Evaluation of hidden HIV infections in an urban ED with a rapid HIV screening program

Hsieh

Kelen

Beck

et al. 2016

The American Journal of Emergency Medicine

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Background To investigate the prevalence of undiagnosed HIV infections in an emergency department (ED) with an established screening program. Methods Evaluation of the prevalence and risk factors for HIV from an 8-week (6/24/2007 – 8/18/2007) identity-unlinked HIV serosurvey, conducted at the same time as an ongoing opt-in rapid oral-fluid HIV screening program. Testing facilitators offering 24/7 bedside rapid testing to patients aged 18–64 years, with concordant collection of excess sera collected as part of routine clinical procedures. Known HIV positivity was determined by (1) chart review or self-report from the screening program, and/or (2) presence of antiretrovirals in serum specimens. Results Among 3,207 patients, 1,165 (36.3%) patients were offered an HIV test. Among those offered, 567 (48.7%) consented to testing. Concordance identity-unlinked study revealed that the prevalence of undiagnosed infections was: 2.3% in all patients; 1.0% in those offered testing versus 3.0% in those not offered testing (p<0.001); and 1.3% in those who declined testing compared to 0.4% in those who were tested (p=0.077). Higher median viral loads were observed in those not offered testing (14,255 copies/mL, IQR: 1,147 – 64,354) versus those offered testing (1,865 copies/mL, IQR: undetectable – 21,786) but the difference was not statistically significant. Conclusions High undiagnosed HIV prevalence was observed in ED patients who were not offered HIV testing and those who declined testing, compared to those who were tested. This indicates that even with an intensive facilitator-based rapid HIV screening model, significant missed opportunities remain with regard to identifying undiagnosed infections in the ED.

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Section: Discussionmentioning

confidence: 94%

Evaluation of hidden HIV infections in an urban ED with a rapid HIV screening program

Hsieh

Kelen

Beck

et al. 2016

The American Journal of Emergency Medicine

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“…To our knowledge, ours is the first study to report the use of an EMR-based intervention to increase HIV testing among hospitalized patients, a population for which routine HIV testing is recommended (Branson et al, 2006; Moyer et al, 2013) but rarely performed (Voetsch et al, 2012). …”

Section: Discussionmentioning

confidence: 99%

Increased HIV testing among hospitalized patients who declined testing in the emergency department

2015

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Health-care systems have serial encounters with many of the same patients across care settings; however, few studies have examined the role of reoffering HIV testing after a patient declines. We assessed whether an intervention to increase HIV testing among hospitalized patients was associated with increased testing among those who declined a test while in the Emergency Department (ED). We studied 8-week periods pre- and post-implementation of an electronic medical record (EMR)-based intervention to increase HIV testing among hospitalized patients. We included all patients 21–64 years old who had no prior HIV test, declined HIV testing in the ED, and were subsequently hospitalized. We used logistic regression to test for an association between time of hospital admission (pre- vs. post-intervention) and whether an HIV test was performed prior to discharge. Pre- and post-implementation, 220 and 218 patients who declined HIV testing in the ED were hospitalized, respectively. There were no significant demographic or clinical differences among patients pre- and post-implementation. Pre- and post-implementation, the median proportion of patients tested weekly was 6.7% (IQR 6.5%, 10.0%) and 41.4% (IQR 33.3%, 41.9%), respectively (aOR 6.2: 95%CI: 3.6, 10.6). HIV testing increased among hospitalized patients who declined a test in the ED after implementation of an EMR-based intervention. Almost half of the patients who declined testing in the ED ultimately underwent testing after it was reoffered during hospitalization, suggesting that the decision to undergo HIV testing is a dynamic process. Leveraging EMR resources may be an effective tool for expanding HIV testing, and testing should be reoffered to patients who previously declined.

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“…In 2009-2010, a national survey of HIV testing was sent to a random sample of 1,500 nonfederal general medical and surgical hospitals within the U.S. selected from the 4,554 hospitals in the 2006 American Hospital Association (AHA) Annual Survey database. 12 Infectioncontrol practitioners from 754 (50.2%) hospitals responded. We obtained data on HIV prevalence by county, parish, borough, or city ("area") from CDC's national HIV surveillance system, 13 and each hospital was linked to the rate corresponding to the area in which it is located based on its address in the AHA Survey database.…”

Section: Samplementioning

confidence: 99%

“…The results of that national survey, comparing responses in 2009 with those from 2004, have been previously reported. 12 However, that report did not consider factors that might influence screening practices, such as county HIV prevalence, information on state HIV testing regulations, and information on the percentage of admissions of low-income and minority patients at participating hospitals.…”

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confidence: 99%

HIV Screening Practices and Hospital Characteristics in the U.S., 2009–2010

et al. 2013

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HIV Screening Practices in U.S. Hospitals, 2009–2010

Abstract: Since 2004, HIV screening in hospitals increased overall and by department. However, the majority of U.S. hospitals have not adopted the CDC recommendations.

Cited by 10 publications

References 45 publications

Evaluation of hidden HIV infections in an urban ED with a rapid HIV screening program

Evaluation of hidden HIV infections in an urban ED with a rapid HIV screening program

Increased HIV testing among hospitalized patients who declined testing in the emergency department

HIV Screening Practices and Hospital Characteristics in the U.S., 2009–2010

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