Background:
HIV/AIDS is now better understood with regard to disease treatment and prevention but is still not a disease that we can eradicate through preventive measures such as vaccines or elimination of high‐risk behaviors. It is estimated that between 50% and 75% of disease transmission occurs by the 25% of those in this population who are unaware of their status. The Department of Health is setting out to routinize testing of HIV to raise the awareness and detection of this disease. The Centers for Disease Control and Prevention recommends testing all patients ages 13–64 in an acute care setting. Hospitalists can play an important role in this public health mission.
Purpose:
To implement routine HIV testing in the inpatient setting.
Description:
An inpatient pilot using a health educator was started in June 2010 offering any patient ages 13–64 free HIV testing on 3 medical wards. Consent was obtained, brief education regarding testing was done, and an oral swab using Ora‐Quick Advance Rapid HIV‐1/2 Antibody was used. If a preliminary positive test was obtained, an additional blood sample for Western blot test was sent to confirm. Counseling and subsequent linkage to HIV care was provided by a social work team specialized in HIV care for confirmed positive patients. Counseling was also provided regarding high‐risk behavior and negative test limitations. Language barriers were addressed through interpreters. The results showed that 734 patients were approached on the medical wards regarding testing during this time. Four hundred and seventy‐eight tests have been completed for admitted patients on 3 medical wards piloted since mid‐June. Six cases were detected and confirmed as new diagnoses of HIV via the health educator (1.2%). This is a higher percentage than that found in pilot testing of more than 12,321 patients in our institution's emergency department (ED) since January 2008, which revealed 80 positive test results (0.6%). A higher percentage of inpatients were confirmed positive for HIV than among those evaluated in the ED. Hospitalization may be the only point of contact for people who do not routinely access preventive health measures. Hospitalists, as a growing field, will play a major role not only in the traditional area of acute medical illness and systems efficiencies but will also in serving the system well to embrace this public health mission. Education and disease prevention through a health educator to know one's status are a first step toward reducing the spread of this disease. The hospitalist must promote the routinization of HIV testing to further the impact of disease awareness and prevention across the country.
Conclusions:
Routine HIV testing must be embraced by hospitalists, as many new cases can be identified with this technique. Using a health educator on the medical wards has shown to be an effective model for detecting HIV patients with routine screening that otherwise may not have occurred. Hospitalists can have a critical impact on this public health issue.
Disclosures:
D. Rizk ‐ none; C. Monaco ‐ Beth Israel Medical Center—Early Intervention Services, research funding; D. Franchi ‐ Beth Israel Medical Center—Early Intervention Services, research funding; S. Barnett ‐ Beth Israel Medical Center—Early Intervention Services, research funding; N. Salomon ‐ none