title: Implementation of a routine HIV testing policy in an acute medical setting in a UK general hospital: a cross-sectional study.
abstract: OBJECTIVE
  To report the implementation and outcomes of a routine opt-out HIV testing policy in an acute medical unit (AMU) of a district general hospital in an area of high diagnosed HIV prevalence.
  
  
  METHODS
  Since July 2011, all patients aged 16-79 years attending AMU were offered an HIV test as a hospital policy. Consenting and arranging the test was carried out by general medical staff, with training and motivational support by local HIV specialists. A retrospective cross-sectional review was conducted: testing rate and outcomes of those testing HIV seropositive were determined by review of hospital data systems and case notes.
  
  
  RESULTS
  Over a 21-month period, there were 12 682 admissions; 4122 (32.5%) had HIV tests. 20 patients (0.48%) were diagnosed with HIV; 17 (85%) of them were new diagnoses. Compared with those patients targeted as a result of clinical suspicion of HIV (n=6), patients who were diagnosed solely due to the scheme (n=14) had higher baseline CD4 counts (median 111 vs 313 cells/mm(3); p=0.01). Two patients had renal disease which improved on antiretroviral therapy. Two long-term defaulters to HIV care with very advanced disease have re-engaged resulting in excellent clinical outcomes. 11 patients are now on treatment with undetectable HIV viral loads. One contact tested HIV positive.
  
  
  CONCLUSIONS
  Our experience shows that routine opt-out testing can be delivered and sustained by general medical staff in an AMU with no money spent other than laboratory processing of the test. We believe that success and sustainability of this policy is due to the high level of commitment from and ownership by the AMU staff, particularly nurses. Ongoing support and motivation from the HIV team has facilitated the delivery of this policy.
authors.affiliation: Department of Genito-urinary Medicine, Croydon University Hospital, , Croydon, Surrey, UK.
authors.forename: David
authors.initials: D
authors.lastname: Phillips
authors.forename: Alison
authors.initials: A
authors.lastname: Barbour
authors.forename: Jan
authors.initials: J
authors.lastname: Stevenson
authors.forename: Sonja
authors.initials: S
authors.lastname: Draper
authors.forename: Reza
authors.initials: R
authors.lastname: Motazed
authors.forename: Ali
authors.initials: A
authors.lastname: Elgalib
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D006757:Hospital Units; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008131:London / Q000453:epidemiology / Q000208:ethnology; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies
keywords: HIV; Hiv Testing; NHS; Policy; Testing