Routine, Opt-Out HIV Screening: A Houston Perspective on the CDC Recommendation

Issue: In 2006, CDC recommended opt-out, HIV screening be done routinely in health care settings to identify the 25% of individuals living with HIV who do not know their status, subsequently diagnosing individuals earlier in their HIV infection. It is estimated that approximately 5,000 individuals are living with HIV in Houston/Harris County who do not know it. Description: In 2008, a routine, opt-out HIV screening project was implemented in two Level I emergency departments in Houston. These emergency facilities conduct HIV screening 24 hours a day/seven days a week through traditional methodology rather than rapid HIV tests. Laboratory processes have been modified to provide a “rapid” result without a rapid HIV test kit. Lessons Learned: Since implementation, this project has screened nearly 18,000 individuals for HIV. All facilities have advocates of the project, which is a critical component of success. Of those tested, a 0.07% positivity rate has been maintained identifying nearly 130 individuals newly diagnosed with HIV. The opt-out rate has been lower than anticipated – 3% to 5% of those informed of the HIV testing process. Recommendations: This project is unique from other models across the country because Texas law allows for routine, opt-out HIV screening with a general medical consent. HIV screening has been well received by medical providers and the community. The project is currently exploring expansion into two additional emergency departments and four additional community health centers. Routine, opt-out HIV screening should be implemented as a primary HIV prevention tactic in urban epicenters of HIV prevalence.