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Integrating HIV testing into inpatient hospital settings in New York State, United States

A. Urbina1, P. Galatowitsch2, M. Kristos1, R. Gabitto1, A. Gorodnitskiy1, A. Tsiakos1

1St. Vincent Hospital, Medicine, New York, United States, 2St. Vincent Catholic Medical Center, Medicine, NY, United States

Issues: HIV testing is not routinely offered at hospitals in New York State(NYS). Historically, non-medical HIV counselors have performed this service as a consequence of NYS laws requiring separate, written informed consents including pre and post test counseling.
Description: To increase numbers of HIV tests at a 350 bed inpatient hospital in New York City, investigators trained 99 medical house staff (MH) to incorporate HIV testing into routine admissions´ procedures. Investigators:
(1) compared number of inpatient HIV tests offered 15 months PRE and 15 months POST Medical Housestaff training;
(2)conducted pre and post HIV training implementation questionnaires to measure attitude and practice changes, and;
(3) focus groups to explore MHs’ experiences.

Æ unique HIV unknown status admissions 25/day; 750/month
Inpatient HIV tests offered 15 months prior to intervention N= 350 (Æ = 24 tests/month
% admissions HIV tested 3%
# and % HIV+ 50 (14%)

Æ unique HIV unknown status admissions 25/day; 750/month
Inpatient HIV tests offered 15 months POST intervention N= 660 (Æ 44 tests/month)
% admissions HIV tested 6%
# and % HIV+ 45(7%)

Lessons learned: Despite training Medical Housestaff to offer HIV testing to inpatient admissions, testing rates increased to only 6% of unique admissions. Data shows that NYS HIV testing law, which segregates HIV screening from patients’ routine care creates anxieties for patients and erects time constraints and other barriers for providers.

Organizational Barriers to HIV testing Patient Barriers to HIV testing Reasons Health Care Providers did not offer HIV testing
(1) State mandated informed consent forms including requirements for pre and post test counseling create time constraints (2) Delays in ordering and retrieval of HIV test results prior to patient discharge (3) Difficulty locating paperwork and lab losing paper work (1) When HIV testing was offered many patients expressed anxiety and declined testing. (2) Some patients felt “profiled” as high risk and declined testing. (3) Patients reported having no risk factors (4) Some patients at high risk for HIV infection often declined HIV testing (1) Felt patient was not at risk because of their age or relationship status (2) Felt patient would be discharged before result was returned. (3) Did not want patient to react negatively towards them. (4) Testing process required too much time

Next steps: States should change HIV testing laws to permit health care facilities to include HIV screening in the general consent for medical care. Doing so would reduce patient anxiety, streamline services, increase HIV diagnoses and patients´ access to timely care.

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