1278. Comparing rates of routine HIV and HCV screening to estimate the impact of consent on identifying patients with undiagnosed HIV
Session: Poster Abstract Session: HIV: Diagnosis and Screening
Friday, October 5, 2018
Room: S Poster Hall

Background: HIV and HCV are both treatable viruses for which routine screening among specific age cohorts is recommended. New York State requires patient consent prior to screening for HIV but not HCV. To estimate the impact of the consent requirement, we compared rates of HIV and HCV screening.

Methods: We performed a retrospective study of all adult patients admitted to a tertiary-care hospital in the Bronx, NY, between April 2015 and June 2016. During the study period, automated prompts in the electronic medical record facilitated screening for HIV among patients ages 21-64, and for HCV among patients born between1945-1965. We compared the proportions of patients qualifying for screening for HIV, HCV, or both who were appropriately screened prior to discharge to calculate an adjusted risk difference between performance of HIV and HCV screening. Using the local prevalence of undiagnosed HIV, we estimated the number of missed HIV diagnoses attributable to the difference in screening rates.

Results: 21,413 unique hospitalized patients ages 21-64 and/or born between 1945-1965 were analyzed. Among those qualifying for screening for HIV alone or HCV alone, 39.7% and 58.6% were screened prior to discharge, respectively. Among those qualifying for both HIV and HCV screening, 6.7% were screened for HIV alone, 29.3% were screened for HCV alone, and 30.3% were screened for both. The risk difference between HCV and HIV screening adjusted for patient and admission characteristics was 22.0% (95% CI 20.6%-23.4%). Using an estimated prevalence of undiagnosed HIV of 0.2%, this risk difference corresponds to approximately 4 (95% CI 3.6-4.1) missed cases of HIV during the study period.

Conclusion: There was a large difference in the number of patients appropriately screened for HIV compared to HCV. While the requirement for consent was the only operational difference in performing routine screening for HIV compared to HCV, differences in how the two viruses are perceived may also have contributed to the observed difference in screening rates. Nevertheless, our findings suggest that removing the requirement for consent prior to HIV screening may increase the number of cases of previously undiagnosed HIV identified by routine screening.

Aileen Tlamsa, MD, Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, Moonseong Heo, PhD, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, Devin Thompson, BS, Medicine, Montefiore Medical Center, Bronx, NY, Lorlette Moir, MPH, New Hampshire Division of Public Health Services, Department of Health and Human Services, Concord, NH, Shuchin Shukla, MD, Western North Carolina Community Health Services, Asheville, NC, Jeffrey Weiss, MD, Department of Medicine, Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, Alain Litwin, MD, MPH, MS, Medicine, University of South Carolina School of Medicine, Greenville, SC and Uriel Felsen, MD, MPH, Department of Medicine, Montefiore Medical Center, Bronx, NY

Disclosures:

A. Tlamsa, None

M. Heo, None

D. Thompson, None

L. Moir, None

S. Shukla, None

J. Weiss, None

A. Litwin, None

U. Felsen, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.