Routine HIV testing among hospitalized patients in Argentina. is it time for a policy change?
BACKGROUND
The Argentinean AIDS Program estimates that 110,000 persons are living with HIV/AIDS in Argentina. Of those, approximately 40% are unaware of their status, and 30% are diagnosed in advanced stages of immunosuppression. Though studies show that universal HIV screening is cost-effective in settings with HIV prevalence greater than 0.1%, in Argentina, with the exception of antenatal care, HIV testing is always client-initiated.


OBJECTIVE
We performed a pilot study to assess the acceptability of a universal HIV screening program among inpatients of an urban public hospital in Buenos Aires.


METHODS
Over a six-month period, all eligible adult patients admitted to the internal medicine ward were offered HIV testing. Demographics, uptake rates, reasons for refusal and new HIV diagnoses were analyzed.


RESULTS
Of the 350 admissions during this period, 249 were eligible and subsequently enrolled. The enrolled population was relatively old compared to the general population, was balanced on gender, and did not report traditional high risk factors for HIV infection. Only 88 (39%) reported prior HIV testing. One hundred and ninety (76%) patients accepted HIV testing. In multivariable analysis only younger age (OR 1.02; 95%CI 1.003-1.05) was independently associated with test uptake. Three new HIV diagnoses were made (undiagnosed HIV prevalence: 1.58%); none belonged to a most-at-risk population.


CONCLUSIONS
Our findings suggest that universal HIV screening in this setting is acceptable and potentially effective in identifying undiagnosed HIV-infected individuals. If confirmed in a larger study, our findings may inform changes in the Argentinean HIV testing policy.
Infectious Diseases Division, Hospital J. A. Fernández, Buenos Aires, Argentina. eugenia.socias@huesped.org.ar
María Eugenia
ME
Socías
Laura
L
Hermida
Mariana
M
Singman
Gisela
G
Kulgis
Andrés
A
Díaz Armas
Osvaldo
O
Cando
Omar
O
Sued
Héctor
H
Pérez
Ricardo
R
Hermes
José Luis
JL
Presas
Pedro
P
Cahn
D015492:AIDS Serodiagnosis / Q000191:economics / Q000379:methods*; D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010865:Pilot Projects; D015995:Prevalence; D011446:Prospective Studies