Routine HIV testing in acute care hospitals: Changing practice to curb a local HIV epidemic in Vancouver, BC

Early treatment of HIV infection increases life expectancy and reduces infectivity; however, delayed HIV diagnosis remains common. Implementation and sustainability of hospital-based routine HIV testing in Vancouver, British Columbia, was evaluated to address a local HIV epidemic by facilitating ear...

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Bibliographic Details
Published in:	Preventive medicine Vol. 137; p. 106132
Main Authors:	Gustafson, Réka, Demlow, S. Ellen, Nathoo, Afshan, McKee, Geoffrey, MacDonald, Lauren E., Chu, Tianxin, Sandhu, Jat, Grafstein, Eric, Hull, Mark, Chittock, Dean, Carere, Ronald, Krajden, Mel, Sherlock, Christopher H., Harrison, Scott, Buchner, Christopher S., Montaner, Julio S.G., Daly, Patricia
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-08-2020
Subjects:	British Columbia Canada Diagnosis HIV Hospitals Screening Screening Canada British Columbia Hospitals Diagnosis HIV
Online Access:	Get full text
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Summary:	Early treatment of HIV infection increases life expectancy and reduces infectivity; however, delayed HIV diagnosis remains common. Implementation and sustainability of hospital-based routine HIV testing in Vancouver, British Columbia, was evaluated to address a local HIV epidemic by facilitating earlier diagnosis and treatment. Public health issued a recommendation in 2011 to offer HIV testing to all patients presenting to three Vancouver hospitals as part of routine care, including all patients admitted to medical/surgical units with expansion to emergency departments (ED). We evaluated acceptability, feasibility, and effectiveness from 2011 to 2014 and continued monitoring through 2016 for sustainability. Between October 2011–December 2016, 114,803 HIV tests were administered at the three hospitals; an 11-fold increase following implementation of routine testing. The rate of testing was sustained and remained high through 2018. Of those tested, 151 patients were diagnosed with HIV for a testing yield of 0.13%. Review of 12,996 charts demonstrated 4935/5876 (96·9%) of admitted patients agreed to have an HIV test when offered. People diagnosed in hospital were significantly more likely to be diagnosed with acute stage (aOR 1·96, 95% CI 1·19, 3·23) infection, particularly those diagnosed in the ED. This study provides practice-based evidence of the feasibility, acceptability, and effectiveness of implementing a recommendation for routine HIV testing among inpatient and emergency department admissions, as well as the ability to normalize and sustain this change. Routine hospital-based HIV testing can increase diagnoses of acute HIV infection and facilitate earlier initiation of antiretroviral treatment. •This is the largest implementation of routine HIV testing as a standard of practice in a hospital setting evaluated to date.•Practice change was achievable by incorporating routine HIV testing into existing clinical pathways.•Using established public health follow up of new cases successfully linked patients to care and supported testing providers.•While HIV testing increased 11 times, the testing yield met the US CDC recommendation for routine HIV testing.•Routine HIV testing in the Emergency Department was a new and effective environment for identifying acute HIV infection.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0091-7435 1096-0260
DOI:	10.1016/j.ypmed.2020.106132