Background: Approximately 1 in 5 and 1 in 2 of people infected with HIV and HCV respectively in the US are unaware of their infection. Risk based opt-in testing strategies result in missed or delayed diagnoses and may further stigmatize these illnesses. Use of routine opt-out testing increases test uptake and can identify patients with HIV or HCV early, resulting in improved outcomes and decreased transmission. This strategy has not yet been fully accepted or operationalized in many health care settings.
Methods: We implemented routine opt-out HIV and HCV testing for all inpatients using internal medicine resident and nurse driven screening models. Patients were eligible for each test if they had not been tested within 1 year and were not known to be infected. Residents were educated on rationale and protocols for routine opt out testing via one grand rounds lecture (January 2016) and one residency orientation lecture (August 2016). Between March and November 2016, residents were incentivized with gift cards awarded for most tests ordered. Nurses were educated through targeted forums. Instructions were distributed and placed in high traffic areas and HIV 1/2 4th generation Ag-Ab and HCV Ab orders were added to admission order sets. Patients were given a chance to decline after routine opt-out testing was offered and educational brochure provided, in accordance with Maryland law. Positive tests were confirmed using Western Blot initially, later changed to HIV 1/2 differentiation assay; HCV was confirmed with HCV RNA. Those with confirmed infection were linked to care.
Results: 71% of 3814 and 83% of 2219 eligible patients were tested for HIV and HCV; 54 (2%) and 390 (21%) were diagnosed with HIV and HCV respectively (Figure 1). Testing activity averaged 32 HIV and 28 HCV tests per month from January to March 2016 and increased after the noted interventions to an average of 300 HIV and 247 HCV tests per month from January to March 2017.
Conclusion: A high disease burden was found within the studied population, highlighting the benefit of routine opt out testing for HIV and HCV. Empowering residents and nurses to offer screening at time of admission is a viable strategy to scale up testing in the inpatient setting.
T. Brown, None
J. Mignano, None
S. Schmalzle, None