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Implementing Routine HIV Screening in Three Chicago Hospitals: Lessons Learned
Monique Glover Rucker1, Rebecca Eavou2, Kristi L Allgood3
1Sinai Health System, Chicago, IL.
Insights
Routine HIV screening in Chicago hospitals identified new infections and out-of-care patients. Expanding testing beyond emergency departments is crucial to reduce missed opportunities and improve patient linkage to care.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Clinical Medicine
Background:
- Routine Human Immunodeficiency Virus (HIV) screening is a key strategy for early detection and linkage to care.
- Implementation and outcomes of HIV testing programs can vary significantly across different healthcare settings.
Purpose of the Study:
- To describe the implementation and outcomes of routine HIV screening in three Chicago hospitals.
- To evaluate testing volumes, seropositivity rates, and linkage-to-care for newly diagnosed HIV infections.
Main Methods:
- A retrospective analysis of data from three Chicago hospitals was conducted.
- Data included routine testing procedures, testing volume, HIV test results, and linkage-to-care outcomes.
Main Results:
- Over 40,000 HIV tests were administered between January 2012 and March 2014, with significant proportions in emergency departments, inpatient, and outpatient clinics.
- A seropositivity rate of 0.7% was observed, with 43% of positive cases being newly diagnosed. 77% of newly diagnosed patients were linked to care.
- Inpatient settings showed the highest seropositivity rate (0.6%). A substantial percentage of newly diagnosed patients had missed opportunities for earlier testing, with some identified as late testers.
Conclusions:
- Routine HIV screening is effective in identifying new infections and patients with known HIV who are not receiving care.
- Expanding screening to inpatient and outpatient settings, in addition to emergency departments, is essential to minimize missed testing opportunities.
- Successful routine HIV screening programs depend on integration into clinical workflows, leadership support, quality assurance, and adherence to local testing regulations.
Objective:
This study describes routine HIV screening implementation and outcomes in three hospitals in Chicago, Illinois.
Methods:
Retrospective data from three hospitals were examined, and routine testing procedures, testing volume, reactive test results, and linkage-to-care outcomes were documented.
Results:
From January 2012 through March 2014, 40,788 HIV tests were administered at the three hospitals: 18,603 (46%) in the emergency department (ED), 7,546 (19%) in the inpatient departments, and 14,639 (36%) in outpatient clinics. The screened patients varied from 1% to 22% of the total eligible patient population across hospitals. A total of 297 patients tested positive for HIV for a seropositivity rate of 0.7%; 129 (43%) were newly diagnosed and 168 (57%) were previously diagnosed, with 64% of those previously diagnosed out of care at the time of screening. The inpatient areas had the highest seropositivity rate (0.6%). The percentage of newly diagnosed patients overall who were linked to care was 77%. Of newly diagnosed patients, 51% had ≥ 1 missed opportunity for testing (with a mean of 3.8 visits since 2006), and 30% of patients with missed opportunities were late testers (baseline CD4+ counts <200 cells per cubic millimeter).
Conclusion:
Routine screening is an essential tool for identifying new infections and patients with known infection who are out of care. Hospitals need to provide HIV screening in inpatient and outpatient settings--not just EDs--to decrease missed opportunities. Routine screening success will be driven by how notification and testing are incorporated into the normal medical flow, the level of leadership buy-in, the ability to conduct quality assurance, and local testing laws.
