title: HIV testing practices by clinical service before and after revised testing guidelines in a Swiss University Hospital.
abstract: OBJECTIVE
  To determine 1) HIV testing practices in a 1400-bed university hospital where local HIV prevalence is 0.4% and 2) the effect on testing practices of national HIV testing guidelines, revised in March 2010, recommending Physician-Initiated Counselling and Testing (PICT).
  
  
  METHODS
  Using 2 hospital databases, we determined the number of HIV tests performed by selected clinical services, and the number of patients tested as a percentage of the number seen per service ('testing rate'). To explore the effect of the revised national guidelines, we examined testing rates for two years pre- and two years post-PICT guideline publication.
  
  
  RESULTS
  Combining the clinical services, 253,178 patients were seen and 9,183 tests were performed (of which 80 tested positive, 0.9%) in the four-year study period. The emergency department (ED) performed the second highest number of tests, but had the lowest testing rates (0.9-1.1%). Of inpatient services, neurology and psychiatry had higher testing rates than internal medicine (19.7% and 9.6% versus 8%, respectively). There was no significant increase in testing rates, either globally or in the majority of the clinical services examined, and no increase in new HIV diagnoses post-PICT recommendations.
  
  
  CONCLUSIONS
  Using a simple two-database tool, we observe no global improvement in HIV testing rates in our hospital following new national guidelines but do identify services where testing practices merit improvement. This study may show the limit of PICT strategies based on physician risk assessment, compared to the opt-out approach.
authors: Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland.
authors: Katharine E A
authors: KE
authors: Darling
authors: Olivier
authors: O
authors: Hugli
authors: Rachel
authors: R
authors: Mamin
authors: Cristina
authors: C
authors: Cellerai
authors: Sebastien
authors: S
authors: Martenet
authors: Alexandre
authors: A
authors: Berney
authors: Solange
authors: S
authors: Peters
authors: Renaud A
authors: RA
authors: Du Pasquier
authors: Patrick
authors: P
authors: Bodenmann
authors: Matthias
authors: M
authors: Cavassini
mesh_terms: D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006679:HIV Seropositivity / Q000175:diagnosis; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D013557:Switzerland