AEGiS-06IAC: Routine HIV testing in an acute care hospital inpatient setting.

6th International AIDS Conference

San Francisco, California, USA — June 20-23, 1990

Routine HIV testing in an acute care hospital inpatient setting.

Int Conf AIDS 1990 Jun 20-23; 6:332 (abstract no. Th.D.826)
DeCiantis ML, DeBuono B, Scott HD, Carpenter C; Rhode Island Department of Health, Providence, RI, USA

OBJECTIVE: Routine and mandatory HIV testing was established by Rhode Island law in August, 1989. One provision included acute care hospitals whereby HIV testing was to be routinely offered to inpatients age 18-40 beginning January 1990. To assess the staff requirements, patient acceptance, and cost-effectiveness of this service, a six-month pilot project was designed at the Miriam Hospital, a 250 bed Brown University-affiliated general hospital in Providence, RI.

METHODS: Inpatients between 18 and 40 years of age were routinely offered an HIV test by a hospital social worker who was notified of all new admissions. After 48 hours, if not exempted from the program, the social worker would contact the patient to provide HIV counseling and offer HIV testing.

RESULTS: Of the 527 admissions, between July-December, 1989 there were an equal number of males (266) and females (259). Forty-two (8%) were age 21 or below. 295 (56%) were discharged prior to being contacted by the project coordinator, 26 (5%) deemed inappropriate for medical reasons, and 20 (4%) were HIV+ upon admission. An HIV test was ordered by the physician prior to contact by the project coordinator for 15 (3%), 11 (2%) did not speak English, 11 (2%) were re-admissions during this time period. Of the remaining 146 patients pre-test counseled and offered an HIV test, 126 (24%) refused and 20 (4%) accepted. Blood work was lost for 7 of these individuals with the remaining 13 blood specimens testing negative. Problems included patient/medical record availability. Multiple attempts were required to reach 33% (173) of the patients. Staff time cost per admission was $8.48, vs $30.64 per patient receiving pre-test counseling vs $224 per patient agreeing to be tested.

CONCLUSION: The high level of patient refusal (86%) raises questions concerning the basic feasibility of routine HIV testing as a casefinding procedure in hospitals. Given that not one HIV positive inpatient was identified, routine testing of hospital inpatients did not appear to be cost effective and HIV testing resources could be better served if offered to patients in more high risk settings.

Keywords: AEGIS, HIV, HIV Infections, Counseling, HIV Seroprevalence, HIV Antibodies, Mass Screening, HIV Core Protein p24, Inpatients, Cost-Benefit Analysis, HIV Envelope Protein gp120, Hospitals, HIV Envelope Protein gp160, Mandatory Testing, HIV Seronegativity, HIV Envelope Protein gp41, Risk, Rhode Island, Human, Female, Male, economics, immunology, ICA6

900620
ThD826