Routine HIV Screening in Texas: Implementing the 2010 National HIV/AIDS Strategy

Calling for “a renewed commitment” and “increased public attention [to HIV/AIDS]”, the National HIV/AIDS Strategy (NHAS) summons the medical community to participate in the fight against HIV/AIDS.  A comprehensive response to NHAS requires increased coordination between public health and healthcare settings.  Over 100 Texas healthcare settings implemented the NHAS, specifically routine HIV screening (RS).

Broadening its scope beyond risk-based targeted testing (RBTT), Texas expanded its testing strategies to include RS for patients ≥13 years in healthcare settings. Successful RS requires collaborating with healthcare setting leadership teams and identifying champions in those settings, utilizing lab-based testing, incorporating RS into electronic medical systems, and connecting healthcare settings with HIV medical services for linkage-to-care. 

Using these methods, Texas works with over 100 healthcare settings performing RS.  From 2008-2013, Texas exceeded one million routine HIV tests.  Of those tested, 52% were female, 41% Hispanic, 30% Black and 45% aged 19-34.  The RS positivity rate is 0.9% with 75% of the HIV-infected persons being male, 52% Black, and 41% aged 19-34. 

Universally incorporating RS as a testing strategy can help the United States effectively implement the NHAS goals: new infections are identified, patients are linked-to-care and race and ethnic minorities are tested, thereby identifying patients with HIV-related disparities.  It is recommended and feasible for other jurisdictions to adopt integrated RS as a standard of medical care.  Texas’ method serves as a model for other jurisdictions.  Likewise, the medical community early adopters can serve as champions for other healthcare settings by facilitating implementation.