Aggressive HIV Testing: A NYC public healthcare system-wide initiative

NYC Health and Hospitals Corporation (HHC) is a public benefit corporation with 11 hospitals, 4 nursing homes, 6 diagnostic/treatment centers, 80+ satellite clinics, home health and managed care agencies. It is affiliated with major NYC medical schools of 42,000+ employees providing services to largely disadvantaged, indigent, diverse population; many new and undocumented immigrants. An estimated 20,000 New Yorkers, one in five people living with HIV, do not know they are infected. NYC remains epicenter of HIV/AIDS epidemic in the US, with highest number of AIDS diagnoses in the country. Among people under 65, HIV is third leading cause of death in NYC. The rise in HIV among minorities is alarming and by making testing available in as many settings as possible, and as a routine medical screening, HHC is increasing the number of early detections. HHC's 11 hospitals are designated AIDS centers and the 6 diagnostic/treatment centers and 80+ clinics offer HIV testing/care to all New Yorkers regardless of ability to pay or immigration status. The Corporate Quality Assurance Committee (QAC) of Board of Directors charged its facilities to utilize quality improvement processes and implement/monitor system-wide initiative. HHC tested 187,732 in FY 2009, 17% increase from 161,089 tested in 2008 and 200% increase from 4 years ago. More than 1,800 patients tested 2009 learned they were HIV positive and were linked to follow-up care. Implementation of best practices and standardized monitoring led to unprecedented acceptance rate to be tested (about 29,000 patients – more than 90% of those approached) agreed to be tested.