Integration of HIV Testing within Routine Care in a Large Public Hospital System

Issues: In 2005, the largest municipal hospital system in the nation initiated an HIV testing expansion initiative to: 1) increase the number of patients who know their HIV status; 2) identify individuals early in their disease, and 3) retain identified patients in care.

Description: Seventeen hospitals and clinics participated. After training clinicians and staff, facilities: adopted the use of rapid HIV tests; offered HIV testing in outpatient clinics, inpatient care and emergency rooms; integrated testing into routine care, and urged physicians to offer the test.

Lessons Learned: Testing increased by 64% (58,785/92,123). 9.49% of total patients were tested, an increase of 56%. The number of positive patients more than doubled, from 720 in FY05 to 1,514 in FY06. The prevalence of HIV varied across facilities and was 1.64% among all patients tested. 76% of newly positive patients received and kept their first appointment for HIV primary care (589/774).

Recommendations: The use of rapid tests and the integration of testing within routine care can significantly increase the number of positive individuals identified and identify individuals who would otherwise be unaware of their status. The rate of testing acceptance and follow-up appointment compliance may be affected by site of test and the offering process used. Methods used and lessons learned provide significant insight for other health care institutions considering the initiation or expansion of HIV testing.