Implementing routine HIV testing in a Washington, DC hospital using 4th generation testing technology

Issues:  In Washington, D.C. 15,056 residents or 2.4% of the population was living with HIV in 2011 with the highest disease rates east of the Anacostia River.  

Description:  The United Medical Center (UMC) is the sole safety net hospital east of the Anacostia River where DC citizens reside with the highest rates of poverty and chronic disease.  In 2011, UMC initiated an Emergency Department (ED)-based, routine HIV screening program.  The goal of the program has shifted from screening via dedicated testers to expanding HIV screening to all ED and inpatients.  In 2010, UMC modified the general conditions of patient admission to include HIV screening.  Upon integration of the fourth generation test within the lab, the goal is to test 21,000 UMC patients over the next 15 months with immediate linkages to HIV care for 100% of new positives.  A three-pronged strategy to expand testing will be implemented to include: 1. Standing orders for all admitted patients including mothers in labor and delivery, 2. incorporation of HIV testing for all phlebotomized patients and 3. A standing offer for all patients triaged to the low acuity treatment area, Fast Track.  An immediate linkage to services program was established in 2011 and is effective in facilitating linkage to care; however, this service is not available after hours and will be incorporated into the new strategy. 

Lessons Learned:  UMC has tested over 12,000 patients since program inception with an initial new positivity rate of 2.1% (this rate has declined to 1.2%). Three persons have been identified with acute HIV infection using 4^th generation testing technology.

Recommendations:  Early HIV testing and immediately linking those who test positive into care remains an essential element to combating the epidemic.  HIV should be seen as a chronic, treatable infection and integrated into routine medical care to continue to decrease the number of persons unaware of their HIV infection and to relink persons to care.