title: Evaluation of opt-out inpatient HIV screening at an urban teaching hospital.
abstract: This study evaluated opt-out inpatient HIV screening delivered by admitting physicians, and compared number of HIV tests and diagnoses to signs and symptoms-directed HIV testing (based on physician orders) in the emergency department (ED). The opt-out inpatient HIV screening program was conducted over a one year period in patients who were admitted to the 386-bed University of California San Diego (UCSD) teaching hospital. Numbers of HIV tests and diagnoses were compared to those observed among ED patients who underwent physician-directed HIV testing during the same time period. Survey data were collected from a convenience sample of patients and providers regarding the opt-out testing program. Among 8488 eligible inpatients, opt-out HIV testing was offered to 3017 (36%) patients, and rapid antibody testing was performed in 1389 (16.4%) inpatients, resulting in 6 (0.4% of all tests) newly identified HIV infections (5/6 were admitted through the ED). Among 27,893 ED patients, rapid antibody testing was performed in 88 (0.3%), with 7 (8.0% of all tests) new HIV infections identified. HIV diagnoses in the ED were more likely to be men who have sex with men (MSM) (p = 0.029) and tended to have AIDS-related opportunistic infections (p = 0.103) when compared to HIV diagnoses among inpatients. While 85% of the 150 physicians who completed the survey were aware of the HIV opt-out screening program, 44% of physicians felt that they did not have adequate time to consent patients for the program, and only 30% agreed that a physician is best-suited to consent patients. In conclusion, the yield of opt-out HIV rapid antibody screening in inpatients was comparable to the national HIV prevalence average. However, uptake of screening was markedly limited in this setting where opt-out screening was delivered by physicians during routine care, with limited time resources being the major barrier.
authors.affiliation: a Division of Infectious Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , USA.|b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.
authors.forename: Georgina
authors.initials: G
authors.lastname: Osorio
authors.affiliation: b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.|c Division of Pulmonology, Department of Internal Medicine , Medical University of Graz , Graz , Austria.|d Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine , Medical University of Graz , Graz , Austria.
authors.forename: Martin
authors.identifier: 0000-0002-1653-2824
authors.initials: M
authors.lastname: Hoenigl
authors.affiliation: e Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Quartarolo
authors.affiliation: f Internal medicine, Scripps HealthCare , La Jolla , USA.
authors.forename: Khamisah
authors.initials: K
authors.lastname: Barger
authors.affiliation: b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.
authors.forename: Sheldon R
authors.initials: SR
authors.lastname: Morris
authors.affiliation: b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.|g Department of Pathology , University of California San Diego (UCSD) , San Diego , USA.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Reed
authors.affiliation: h Department of Medicine , Stritch School of Medicine, Loyola University of Chicago , Maywood , USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Lee
authors.affiliation: b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Little
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D015995:Prevalence; D015397:Program Evaluation; D014505:Urban Population
keywords: HIV surveillance; HIV testing; emergency department; healthcare setting; routine