Ruling out HIV with routine screening in an LA medical center

Issue:  At the end of 2012 a cumulative total of 59,500 persons were living with HIV/AIDS in Los Angeles County. The bulk of these undiagnosed cases are thought to reside in the Metro Los Angeles area where Los Angeles County Hospital at the University of California (LAC+USC) is the largest health service provider.  This hospital is one of the largest public hospitals in the country and has a level one trauma center. 

Description:  Employing universal HIV screening in the Emergency Department (ED) at LAC+USC offers an otherwise medically and socially marginalized patient population earlier linkage to HIV medical care and therefore greater access to life altering therapeutics.  The ‘Rule Out HIV in the LAC+USC ED’ program screens all ED patients able to provide verbal opt out consent. A team of experts and champions from fields including emergency medicine, family medicine, laboratory sciences, HIV care, public health, nursing and hospital administration were assembled to execute this ambitious program.

Lessons Learned:    In LA, since March 2011-Aug 2013 there have been over 17,847 patients screened for HIV and identifying 760 cases of HIV of which 97 (.54% positivity rate) were previously undiagnosed and over 90% of new diagnoses were successfully linked to HIV care (53% re-linkage to care rate). 

Recommendations:   Opt-out routine HIV testing needs to be expanded nationally in medical centers to accelerate the reduction of persons undiagnosed with HIV.  Given that in LA that is approximately 12,781 cases alone it may be insurmountable without routine testing.