title: Patient risks, outcomes, and costs of voluntary HIV testing at five testing sites within a medical center.
abstract: OBJECTIVE
  The Centers for Disease Control and Prevention (CDC) recommends offering human immunodeficiency virus (HIV) testing to all patients in all high HIV-prevalence clinical settings. We evaluated programmatic aspects of HIV testing across multiple clinical settings within a single medical center.
  
  
  METHODS
  We analyzed programmatic data of HIV testing in the Urgent Care Center (UCC), inpatient floors, outpatient primary care, a non-clinical Drop-In Center, and Emergency Department (ED). HIV testing was by oral mucosal transudate, venous blood samples, or rapid testing fingersticks, with Western blot confirmation. We compared the sociodemographics and behavioral risks of individuals undergoing HIV testing across the five sites and estimated costs per person tested and per HIV-positive test result.
  
  
  RESULTS
  From 2002 to 2004, 16,750 HIV tests were conducted, with 229 (1.4%) previously unreported HIV infections diagnosed among 16,696 valid test results. HIV-positive prevalence was 1.5% for the UCC, 1.5% at the Drop-In Center, 1.4% for primary care, 1.2% for inpatient, and 0.6% in the ED. Behavioral risks were most prevalent in the UCC and the Drop-In Center. The cost per test was lowest in the UCC and highest in the Drop-In Center. The cost per previously unreported HIV infection was lowest in the UCC ($1,980) and highest in the ED ($9,724).
  
  
  CONCLUSIONS
  Although a significant number of HIV infections were identified, the number of tests performed represents < 10% of all clinical visits. Due to personnel and time constraints, offering HIV testing to patients hierarchically in some settings of a high-volume medical center merits evaluation.
authors.affiliation: Department of Epidemiology and Biostatistics, University of Illinois, 958 SPHPI, M/C 923, 1603 W. Taylor St., Chicago, IL 60612, USA. supriyad@uic.edu
authors.forename: Supriya D
authors.initials: SD
authors.lastname: Mehta
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hall
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Greenwald
authors.forename: Kevin
authors.initials: K
authors.lastname: Cranston
authors.forename: Paul R
authors.initials: PR
authors.lastname: Skolnik
mesh_terms: D000293:Adolescent; D000328:Adult; D001900:Boston / Q000453:epidemiology; D003376:Counseling; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006297:Health Services Accessibility; D017721:Hospital Costs / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics / Q000458:organization & administration*; D006786:Hospitals, Urban / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data; D015995:Prevalence; D015397:Program Evaluation; D018570:Risk Assessment