title: Acceptability and feasibility of universal offer of rapid point of care testing for HIV in an acute admissions unit: results of the RAPID project.
abstract: BACKGROUND
  UK guidance recommend all acute medical admissions be offered an HIV test. Our aim was to determine whether a dedicated staff member using a multimedia tool, a model found to be effective in the USA, is an acceptable, feasible, and cost-effective model when translated to a UK setting.
  
  
  METHODS
  Between 14(th) Jan to 12(th) May 2010, a Health advisor (HA) approached 19-65 year olds at a central London acute medical admissions unit (AAU) and offered a rapid HIV point of care test (POCT) with the aid of an educational video. Patients with negative results had the option to watch a post-test video providing risk-reduction information. For reactive results the HA arranged a confirmatory test, and ensured linkage into HIV specialist care. Feasibility and acceptability were assessed through surveys and uptake rates. Costs per case of HIV identified were established.
  
  
  RESULTS
  Of the 606 eligible people admitted during the pilot period, 324 (53.5%) could not be approached or testing was deemed inappropriate. In total 23.0% of eligible admissions had an HIV POCT. Of the patients who watched the video and had not recently tested for HIV, 93.6% (131/140) agreed to an HIV test; four further patients had an HIV test but did not watch the video. Three tests (2.2%, 3/135) were reactive and all were confirmed HIV positive on laboratory testing. 97.5% felt HIV testing in this setting was appropriate, and 90.1% liked receiving the information via video. The cost per patient of the intervention was £21.
  
  
  CONCLUSIONS
  Universal POCT HIV testing in an acute medical setting, facilitated by an educational video and dedicated staff appears to be acceptable, feasible, effective, and low cost. These findings support the recommendation of HIV testing all admissions to AAU in high prevalence settings, although with the model used a significant proportion remained untested.
authors.affiliation: Research Department of Infection & Population Health, University College London, London, United Kingdom. f.burns@ucl.ac.uk
authors.forename: Fiona
authors.initials: F
authors.lastname: Burns
authors.forename: Simon G
authors.initials: SG
authors.lastname: Edwards
authors.forename: Jeremy
authors.initials: J
authors.lastname: Woods
authors.forename: Golaleh
authors.initials: G
authors.lastname: Haidari
authors.forename: Yvette
authors.initials: Y
authors.lastname: Calderon
authors.forename: Jason
authors.initials: J
authors.lastname: Leider
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
authors.forename: Rose
authors.initials: R
authors.lastname: Tobin
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cartledge
authors.forename: Michael
authors.initials: M
authors.lastname: Brown
mesh_terms: D015492:AIDS Serodiagnosis / Q000191:economics / Q000379:methods*; D000328:Adult; D004636:Emergency Service, Hospital; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D019095:Point-of-Care Systems; D006113:United Kingdom / Q000453:epidemiology