title: Ten Sites, 10 Years, 10 Lessons: Scale-up of Routine HIV Testing at Community Health Centers in the Bronx, New York.
abstract: OBJECTIVE
  In response to the current CDC recommendations for routine HIV testing in clinical settings, the Adolescent AIDS Program at Montefiore Medical Center in the Bronx, New York, developed the Advise, Consent, Test, Support routine HIV testing model (ACTS) in 2003. ACTS was piloted in 10 community health centers operated by Montefiore because they serve populations most at risk for HIV/AIDS.
  
  
  METHODS
  ACTS streamlined and codified the counseling and testing process, provided a routine HIV testing practice change plan, and provided training and communication materials that promoted routine HIV testing. To determine program success, we measured the number of patients seen at the clinics, the number of HIV test-eligible patients (those aged 13-64 years and not pregnant), the number and percent of patients receiving HIV testing, HIV test results, and the number of patients linked to care.
  
  
  RESULTS
  HIV testing in the 10 sites increased nearly threefold during the pilot period (2003-2007), from 3,944 of 49,125 eligible patients (8%) tested in 2003 to 11,212 of 55,629 eligible patients (20%) tested in 2007. With little ongoing support, the sites continued or maintained improvements: 13,226 of 56,686 eligible patients (23%) were tested in 2008, 15,965 of 57,025 eligible patients (28%) were tested in 2011, 17,483 of 60,514 eligible patients (29%) were tested in 2012, and 17,971 of 63,172 eligible patients (28%) were tested in 2013. Sites identified 433 HIV-positive patients from 2006 to 2013 (0.2%-0.6% annual seropositivity), and 96% of them were linked to care within 90 days of HIV diagnoses (range: 92% to 98% annually).
  
  
  CONCLUSIONS
  ACTS demonstrated that substantial and sustained increases in routine HIV testing can be achieved in health-care settings, not by adding personnel or financial resources, but by using the model's practice change plan and streamlined HIV testing approach.
authors: Montefiore Medical Center, Adolescent AIDS Program, Bronx, NY.
authors: Donna
authors: D
authors: Futterman
authors: Montefiore Medical Center, Adolescent AIDS Program, Bronx, NY.
authors: Stephen
authors: S
authors: Stafford
authors: Montefiore Medical Center, Office of Research Program Development, Bronx, NY.
authors: Paul
authors: P
authors: Meissner
authors: Montefiore Medical Center, Adolescent AIDS Program, Bronx, NY.
authors: Michelle
authors: M
authors: Lyle-Gassama
authors: Albert Einstein College of Medicine, Department of Family and Social Medicine, Bronx, NY.
authors: Arthur
authors: A
authors: Blank
authors: Montefiore Medical Center, Adolescent AIDS Program, Bronx, NY.
authors: Lindsay
authors: L
authors: DuBois
authors: Montefiore Medical Center, Department of Family and Social Medicine, Bronx, NY.
authors: Jonathan
authors: J
authors: Swartz
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D003151:Community Health Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D055815:Young Adult