Implementation of the revised CDC HIV testing recommendations: Ensuring sustainability and routinization of rapid testing in a hospital-wide system

Issues: The CDC recommended integrating opt-out HIV screening into routine clinical care in all health care settings (Sept 2006). Implementation of these recommendations needs further exploration, including models of care that adapt to specific clinical settings. Description: At a single hospital, rapid HIV testing was employed in various affiliated settings using site-specific implementation models: delivery room (DR) (2002); FP/OB/GYN clinic (2003); partner-testing in an HIV practice (2004); and emergency department (ED) (2007). Lessons Learned: Screening models need to be site-specific. In the DR, OB residents screened with serum HIV rapid tests, processed in the hospital lab, with results returned within one hour. Seropositivity rate was 0.8%. In the FP/OB/GYN clinic, a dedicated HIV counselor performed the rapid HIV point of care test using oral swab. Testing responsibilities transitioned to permanent clinic staff after three years. Of >2,400 tests, seropositivity rate was 0.9% (7.8% for walk-ins). The HIV clinic utilized clinic staff to test partners with HIV rapid point of care testing in 2004. In the ED, dedicated HIV counselors were embedded Feb 2007. A capacity-building plan has been implemented to transition testing to permanent staff in two years. Future plans are to establish rapid HIV testing in all hospital-affiliated inpatient and outpatient settings. Recommendations: Capacity building, integration and buy-in of staff is essential in the initial planning phase of implementation of the CDC revised testing guidelines. This session will explore different implementation models that were adapted for specific settings to ensure sustainability.