Experiences in implementation of routine human immunodeficiency virus testing in a US tuberculosis clinic.
METHODS
Rhode Island Tuberculosis (RI TB) Clinic, The Miriam Hospital, Providence, RI, USA.


BACKGROUND
Human immunodeficiency virus (HIV) status is a critical factor in the management of both patients with latent TB infection (LTBI) and active TB. Since 2006, the Centers for Disease  Control and Prevention has recommended routine, opt-out HIV testing in all health care settings, including TB clinics. However, implementation of HIV testing in LTBI patients has been limited.


METHODS
A policy for HIV assessment of all new patients was instituted at the RI TB Clinic. Patients  who reported no HIV testing in the preceding year were offered opt-out HIV testing. Patient records (June 2010-June 2011) were retrospectively reviewed. Structured nursing interviews assessed staff acceptance.


RESULTS
A total of 821 (77.5%) first-visit TB patients underwent HIV status  assessment: 96.3% of those not tested in the previous year agreed to testing; 65.9% of tests were performed at point of care. There was one new HIV diagnosis.


CONCLUSIONS
Implementing routine opt-out HIV testing in the RI TB Clinic is feasible, with high staff acceptance rates and low patient  refusal rates. Perceived health systems barriers can be overcome. Incorporating opt-out HIV testing for LTBI patients expands testing opportunities to individuals unaware of their HIV status, and can identify HIV-infected patients early in the course of infection.
Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. Adriangardner1@gmail.com
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Gardner
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Naureckas
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Beckwith
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Losikoff
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D000328:Adult; D001291:Attitude of Health Personnel; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010342:Patient Acceptance of Health Care; D010465:Perception; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D016730:Program Development; D015397:Program Evaluation; D012017:Referral and Consultation; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy