Routinely offering HIV tests to people in hospitals helps more people get tested, and know their status
For about eight months in 2014 and 2015, a medical care center in the Bronx prompted hospital health care providers, through an electronic medical records system, to offer HIV tests to patients. It wasn’t a blanket recommendation, and patients had to opt-in to the HIV testing once it was offered, but it did significantly expand HIV testing and diagnose many people living with HIV who were unaware of their status.
Perhaps not surprisingly, the results of this expanded screening were beneficial: The HIV test reminder program increased the likelihood that HIV tests were provided to people admitted to hospitals. Importantly, the program also increased the percentage of new positive HIV diagnoses by about 3.5-fold. During the standard of care period, the rate of positive HIV diagnoses was 8.2 (per 100,000); during the testing program, this rate rose to 37 (per 100,000).
The expanded testing program was relatively simple. It involved an electronic prompt that health care providers received, reminding them to offer an HIV test to eligible patients. Reminders were offered for an HIV test if a patient either had no HIV test result recorded in their file, or, if they had an indicator of HIV risk recorded (e.g., a sexually transmitted infection diagnosis) since their last HIV test. HIV counselors on staff responded to HIV test requests and provided services in English and Spanish.
“These findings provide important insights for those seeking to expand HIV testing among hospitalized patients,” said Uriel Felson, MD, MPH, MS and colleagues. “By focusing on those with no documented HIV test regardless of risk and those with known risk after their last negative test, to our knowledge, our strategy represents the closest approximation to implementing the [current HIV screening] guidelines that is available in the literature.”
HIV testing programs often need to balance the competing priorities of coverage and cost. Testing as many people as possible increases the likelihood that most, or all, people living with HIV receive a diagnosis. Yet often HIV testing programs are only able to provide more targeted HIV testing to people anticipated to be at greater risk if limited by cost.
The HIV testing team at San Francisco AIDS Foundation, for example, conducts active outreach to gay and bisexual men and people along the trans spectrum. “We work to meet the needs of communities with the highest rates of infection,” said Brittany Maksimovic, manager of HIV testing services. “However, our team also values providing services to those who do not fall into those categories. We’re always available to run an HIV test for anyone interested.”
One critical goal of project conducted in the Bronx was to increase HIV testing among populations of people historically underserved by HIV testing services, including ethnic and racial minorities. The program seemed to accomplish this goal, with the percentage of Hispanic, Black and Asian patients opting for an HIV test increasing significantly during the program. The percentage of people from racial and ethnic minorities being tested for HIV rose from about 10% to more than 20%.
“Our strategy was associated with a diversification of the patients tested,” said Felson and colleagues. “Our finding of increased testing across all measured patient characteristics, and the attenuation of independent associations between those characteristics and performance of an HIV test, reflects expansion both of volume and population needs.”
Do you know your status? Get tested for HIV and STIs for free at San Francisco AIDS Foundation.
Felsen, U. and colleagues. Expanded HIV testing strategy leveraging the electronic medical record uncovers undiagnosed infection among hospitalized patients. JAIDS, May, 2017.