Routine, Opt-out HIV Screening: A Houston Perspective On the CDC Recommendation

Background: In 2006, CDC recommended opt-out HIV screening be done routinely in medical settings to identify the 25% of individuals living with undiagnosed HIV infection, subsequently diagnosing individuals earlier in their HIV infection.  Approximately 5,000 individuals are living with undiagnosed HIV infection in Houston/Harris County.  

Objectives: HIV disproportionately affects populations who have a history of barriers to care, which may contribute to delayed diagnosis and further transmission of HIV.  To reach these individuals, a routine, opt-out HIV screening project has been implemented in three emergency departments (two Level I and one Level III) in Houston where HIV screening is conducted 24 hours a day/seven days a week through conventional methodology. 

Methods: A three-step process was used to 1) prepare project sites for implementation; 2) address site-specific logistical considerations; and 3) train staff throughout these sites.  Laboratory processes have been modified to provide a “rapid” result without a rapid HIV test kit, and all HIV tests performed utilize conventional, venipuncture testing technologies.  Each program site has dedicated Disease Intervention Specialist staff to ensure immediate offering of partner services.

Results: During the initial 16 months of screening activities, 55,254 individuals were screened for HIV and 526 individuals were newly identified with HIV.  An additional 694 individuals were identified with previously diagnosed HIV and re-engaged with primary medical services.  The overall positivity rate across all sites is 2.21% while the newly diagnosed positivity rate is 0.95%.  The overall opt-out rate across all sites is 2.22%.

Conclusions: While many emergency departments are using rapid testing technology for routine HIV screening, this project demonstrates that hospital laboratories can increase their stat testing capabilities to allow for "rapid" results with conventional technologies. 

Implications for Programs, Policy, and/or Research: Measuring the cost effectiveness of conventional technologies may be a vital tool in developing long term sustainable screening efforts in medical settings.