Background:
The Centers for Disease Control and Prevention recommended in 2006 to test all patients for HIV without requiring counseling or written consent. The CDC suggested “opt‐out” testing to increase adoption. In 2007, California removed the legal requirement for written consent. However, the volume of HIV tests in the University of California, San Francisco infectious disease laboratory did not increase after either the CDC statement or the change in law. The objective of this study was to determine the prevalence of undiagnosed HIV and the practicality of implementing universal opt‐out HIV screening for all medicine service inpatients ages 18–65.
Methods:
This was a single‐center prospective pilot program run for 1 year on a nonteaching academic medicine service to evaluate 3 outcome measures: (1) number of patients with newly identified HIV infections; (2) identify barriers to physician‐administered HIV screening; (3) translatability of the pilot to a larger academic medical center setting. All providers admitting patients to the medicine service were informed of the opt‐out HIV screening program by an educational meeting or e‐mail memo. A prompt for HIV screening information was added to the electronic admission note. When eligible patients were not screened on admission, practitioners were contacted via e‐mail to encourage next‐day screening. Data were collected by a single analyst and documented in a secure hospital intranet repository. All identifiers were stripped prior to data analysis.
Results:
During the initial 6 months of the study, 203 patients between ages 18 and 65 were admitted to the medicine ward involved in this pilot. Of these, 12 (5.9%) were known HIV‐positive persons, and 69 (34%) were not tested. Of the newly tested patients, 1 (0.82%) tested HIV positive, and 1 (0.82%) tested inconclusive. Of the 69 untested persons, the most common reasons were physician omission (32 patients, 46%), patient report of recent negative (15 patients, 22%), patient refusal (14 patients, 20%), practitioner preference due to terminal diagnosis (7 patients, 10%), and patient inability to consent due to cognitive disturbance (5 patients, 7%).
Conclusions:
This study shows that a universal opt‐out HIV screening program in an inpatient setting yields a similar percentage of newly detected HIV infections as previous emergency department studies. This study used real‐time personal interaction between researcher and clinician to explore physicians’ barriers to ordering an HIV test. These barriers included forgetting, misunderstanding the state law, screening only perceived at‐risk persons, and discomfort raising this topic with an ill patient. Considering the relatively low number of patients to refuse screening, this study suggests that patient attitudes regarding HIV testing have shifted. Further evaluation of physician attitudes and increased education regarding the CDC recommendations and changes in state law are necessary to increase HIV screening rates.
Disclosures:
A. K. Abramson ‐ none; E. Machtinger ‐ none