Identifying undiagnosed human immunodeficiency virus: the yield of routine, voluntary inpatient testing.
BACKGROUND
Despite current recommendations for human immunodeficiency virus (HIV) counseling and testing among patients admitted to hospitals with at least a 1% prevalence of HIV infection, an estimated 300 000 people in the United States remain unaware of their HIV infection.


METHODS
We implemented the Think HIV program, which offered voluntary HIV counseling and testing to patients admitted to the medical service of a Boston, Mass, teaching hospital. We compared the results of this effort with testing results from a 15-month historical control period.


RESULTS
Patients admitted during the program period were 3.4 times more likely to undergo testing for HIV than those admitted during the control period (95% confidence interval [CI], 2.8-4.1). The testing program detected approximately 2 new diagnoses of HIV infection per month, compared with 1 per month during the control period. Patients who underwent testing during the program, and who likely would not have done so without this initiative, had an estimated prevalence of HIV infection of 3.8% (95% CI, 1.8%-5.8%).


CONCLUSIONS
Testing efforts for HIV targeted to only symptomatic patients are inadequate to identify the one third of HIV-seropositive people in the United States who are unaware of their infection. We have shown that in a single urban hospital, offering voluntary, routine inpatient HIV counseling and testing can be successful as a screening program by identifying a substantial number of patients with undiagnosed HIV. These patients then can be informed, counseled, and linked to care and treatment. Seventy-two hospitals nationwide have demographics similar to those of the study hospital, suggesting that these results are generalizable to many urban hospitals.
Walensky
Rochelle P
RP
Division of Infectious Disease and Partners AIDS Research Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St, Ninth Floor, Boston, MA 02114, USA. rwalensky@partners.org
Losina
Elena
E
Steger-Craven
Kathleen A
KA
Freedberg
Kenneth A
KA
D000328:Adult; D001900:Boston / Q000453:epidemiology; D003376:Counseling / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D015528:HIV Seroprevalence; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data*; D008875:Middle Aged; D010865:Pilot Projects; D014505:Urban Population / Q000706:statistics & numerical data