An Expanded HIV Testing Strategy Leveraging the Electronic Medical Record Uncovers Undiagnosed Infection among Hospitalized Patients

Background: Recommendations for expanded HIV testing include routine screening of hospitalized patients, but little is known regarding effective strategies to expand screening in the hospital setting. We assessed the impact of an electronic medical record (EMR) prompt on HIV testing for hospitalized patients.

Methods: We performed a quasi-experimental, pre-post study at three hospitals in the largest health system in the Bronx, NY. We compared the proportion of admissions of patients 21-64 years old with an HIV test performed, characteristics of patients tested, and rate of new HIV diagnoses made by screening while a prompt recommending HIV testing was inactive vs. active. The prompt appeared for patients with no prior HIV test or a high-risk diagnosis after the last negative test

Results: During 377 days with the prompt inactive, 3,486 of 36,610 admissions (9.5%) had an HIV test performed. During 199 days with the prompt active, 4,122 of 18,943 admissions (21.8%) had an HIV test performed. Admission while the prompt was active was associated with increased HIV testing among total admissions (aOR 2.78, 95%CI 2.62-2.96), admissions of those without a prior test (aOR 4.03 95%CI 3.70-4.40), and admissions of those with a prior negative test (aOR 1.52, 95%CI 1.37-1.68) (p<0.0001 for all). While the prompt was active, testing increased across all patient characteristics. New HIV diagnoses made by screening increased from 8.2/100,000 admissions to 37.0/100,000 admissions while the prompt was inactive and active, respectively (OR 4.51 95%CI 1.17-17.45, p= 0.03).

Conclusion: An EMR prompt for hospitalized patients was associated with a large increase in HIV testing, a diversification of patients tested, and an increase in diagnoses made by screening. Leveraging the EMR to support expanded HIV testing strategies for hospitalized patients can impact key HIV prevention outcomes including decreasing missed opportunities for diagnosis.