HIV testing and referral to care in U.S. hospitals prior to 2006: results from a national survey.
OBJECTIVE
We sought to provide a benchmark for human immunodeficiency virus (HIV) testing availability and practices in U.S. hospitals prior to the Centers for Disease Control and Prevention's (CDC's) 2006 revised recommendations.


METHODS
We conducted a survey of nonfederal general hospitals in the U.S. in 2004. Chi-square tests detected significant associations with hospital characteristics. Questionnaires were completed electronically via a secure Internet site or on paper. Nonresponse analysis was conducted and data were weighted to adjust for nonresponse.


RESULTS
HIV testing (on the basis of clinical symptoms or behavioral risk factors) was available in more than half of hospital inpatient units (62%), employee health departments (58%), and emergency departments (57%). Twenty-three percent offered routine screening (testing for people in a defined population regardless of clinical symptoms or behavioral risk), most commonly in labor and delivery. Teaching status, region, size, and type of metropolitan area were associated with the availability of HIV testing and routine screening (p<0.01). Hospitals used a variety of methods to link patients to care: referral to a hospital-based clinic (36%); on-site, same-day evaluation (35%); and referral to an unaffiliated HIV or community clinic (42%).


CONCLUSIONS
Hospitals offered HIV testing on the basis of clinical suspicion or risk, but were far from meeting CDC's current recommendation to routinely test all patients aged 13 to 64. Hospital size, teaching status, and geographic location were associated with HIV testing availability and testing practices. Our understanding of current practice identifies opportunities for public health action at the practitioner, organization, and systems levels.
Torres
Gretchen Williams
GW
Health Research and Educational Trust, American Hospital Association, 1 N. Franklin St., Ste. 2800, Chicago, IL 60606, USA. gwtorres@uchicago.edu
Yonek
Juliet
J
Pickreign
Jeremy
J
Whitmore
Heidi
H
Hasnain-Wynia
Romana
R
D015492:AIDS Serodiagnosis / Q000592:standards; D000293:Adolescent; D000328:Adult; D002487:Centers for Disease Control and Prevention, U.S.; D003625:Data Collection; D015658:HIV Infections; D006276:Health Facility Size; D006761:Hospitals; D006801:Humans; D007258:Informed Consent; D007297:Inpatients; D008875:Middle Aged; D012017:Referral and Consultation; D012307:Risk Factors; D014481:United States