title: Leveraging a rapid, round-the-clock HIV testing system to screen for acute HIV infection in a large urban public medical center.
abstract: OBJECTIVE
  To describe the prevalence and location of new and acute HIV diagnoses in a large urban medical center. Secondary objectives were to evaluate rapid HIV test performance, the added yield of acute HIV screening, and linkage-to-care outcomes.
  
  
  METHODS
  Cross-sectional study from November 1, 2008, to April 30, 2009.
  
  
  METHODS
  The hospital laboratory performed round-the-clock rapid HIV antibody testing on venipuncture specimens from patients undergoing HIV testing in hospital and community clinics, inpatient settings, and the emergency department (ED). For patients with negative results, a public health laboratory conducted pooled HIV RNA testing for acute HIV infection. The laboratories communicated positive results from the hospital campus to a linkage team. Linkage was defined as 1 outpatient HIV-related visit.
  
  
  RESULTS
  Among 7927 patients, 8550 rapid tests resulted in 137 cases of HIV infection [1.7%, 95% confidence interval (CI): 1.5% to 2.0%], of whom 46 were new HIV diagnoses (0.58%, 95% CI: 0.43% to 0.77%). Pooled HIV RNA testing of 6704 specimens (78.4%) resulted in 3 cases of acute HIV infection (0.05%, 95% CI: 0.01% to 0.14%) and increased HIV case detection by 3.5%. Half of new HIV diagnoses and two thirds of acute infections were detected in the ED and urgent care clinic. Rapid test sensitivity was 98.9% (95% CI: 93.8% to 99.8%) and the specificity 99.9% (95% CI: 99.7% to 99.9%). More than 95% of newly diagnosed and out-of-care HIV-infected patients were linked to care.
  
  
  CONCLUSIONS
  Patients undergoing HIV testing in EDs and urgent care clinics may benefit from being simultaneously screened for acute HIV infection.
authors.affiliation: HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA 94114, USA. christopoulosk@php.ucsf.edu
authors.forename: Katerina A
authors.initials: KA
authors.lastname: Christopoulos
authors.forename: Nicola M
authors.initials: NM
authors.lastname: Zetola
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.forename: Barbara
authors.initials: B
authors.lastname: Haller
authors.forename: Brian
authors.initials: B
authors.lastname: Louie
authors.forename: C Bradley
authors.initials: CB
authors.lastname: Hare
authors.forename: Mark
authors.initials: M
authors.lastname: Pandori
authors.forename: Patricia
authors.initials: P
authors.lastname: Nassos
authors.forename: Marguerite
authors.initials: M
authors.lastname: Roemer
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Pilcher
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D000914:Antibodies, Viral / Q000097:blood*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D003955:Diagnostic Tests, Routine; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006779:Hospitals, Public; D006801:Humans; D007755:Laboratories, Hospital / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood*; D012495:San Francisco / Q000453:epidemiology; D012698:Serologic Tests; D013997:Time Factors; D014342:Truth Disclosure; D019037:Urban Health Services / Q000458:organization & administration*
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral