Normalizing HIV testing in a busy urban sexually transmitted infections clinic

Increased awareness of HIV serostatus is a cornerstone of HIV prevention efforts. Thus, routine HIV testing in clinical settings has been identified as a priority. We report on our experience with making rapid HIV testing a routine procedure in a large STI clinic.

A series of logistical changes were implemented to enhance HIV testing uptake, including introduction of rapid testing, changes in sequence of clinical procedures, and an opt-out consent process. The impact of these changes on HIV testing was measured by the ratio of HIV testing and syphilis RPR testing, with the latter defined as the gold standard of routine testing in an STI clinic setting.

Over time and in relationship to the introduction of clinic changes, the HIV/RPR ratio increased from 0.79 at baseline to 0.96 after full implementation. Overall HIV positivity rates did not vary significantly over time.

After the introduction of several changes in clinic procedures, we experienced an increase HIV testing uptake relative to routine syphilis testing. In STI clinics, HIV testing can be made as normal as other routine STI testing.