Centers Provide Model for HIV Testing in Community Setting

Larry Hand

June 29, 2014

Novel HIV screening programs in New York City and New Orleans, Louisiana, can serve as models for other healthcare centers to follow in providing better screening for local populations, according to an article published online June 26 in Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention (CDC).

Xia Lin, PhD, epidemic intelligence officer at the CDC, and colleagues describe how the Urban Health Plan in New York and the Interim Louisiana Hospital in New Orleans increased the percentage of patients tested and linked to medical care.

In 2006, CDC recommended that healthcare providers screen all patients aged 13 to 64 years for HIV unless prevalence of undiagnosed HIV infection in their patients has been recorded to be less than 0.1%. Many clinical settings are not doing this, however.

"The prevalence of undiagnosed HIV infection at both programs exceeded CDC's recommended threshold (≥0.1%) for routine screening, and most persons previously diagnosed with HIV infection at both programs were not receiving medical care," the authors write.

Both centers received startup funding from Gilead Sciences' HIV on the Frontlines of Communities in the United States to implement routine HIV screening through institutional policy change, integration of HIV testing into clinical workflows, use of electronic health records to prompt testing, and staff education on best practices. Urban Health Plan is continuing the program without external funding.

Urban Health Plan consists of a network of 8 practice sites and 8 school-based centers and serves about 60,000 unique patients a year. Interim Louisiana Hospital serves about 76,000 unique patients a year through its emergency department and urgent care center.

In the New York center, the percentage of patients tested for HIV increased from 8% during calendar year 2010 to 56% during the period from January 2011 to September 2013. On average, the center increased screenings from 188 a month during 2007 to 2010 to 986 a month from January 2011 to September 2013.

Of 32,534 patients screened during the latter period, 148 (0.45%) tested HIV-positive, with the prevalence higher among males, non-Hispanics, and persons aged 31 years old or older. None of the HIV-diagnosed patients had received previous medical care, but the center linked 120 (81%) to subsequent HIV care.

At the New Orleans center, the percentage of patients screened for HIV increased from 17% for the emergency department and 3% for the urgent care center during 2012 to 26% and 17% from mid-March to December 2013. The number of screenings increased from a monthly average of 821 during 2010 to 2012 to 1323 in the 2013 period.

Of 12,568 patients screened during the 2013 period, 102 (0.81%) tested HIV positive, with the prevalence higher among males, blacks, Hispanics, and persons aged 23 to 30 years. The center linked 67 (74%) patients, including 5 with acute HIV infection, to HIV medical care.

Integrating screening into the regular clinic workflow made the programs scalable, and the active linkage to care is an essential element for success.

"Active linkage is an essential element of a routine screening program to ensure that HIV-infected persons receive HIV care and services," the authors write. "These integrated routine HIV screening programs can serve as models for other emergency and primary health-care settings."

June 27 is the 20th anniversary of National HIV Testing day, and the CDC has provided updated recommendations, now available on its Web site.

Morb Mortal Wkly Rep. Published online June 26, 2014. Full text

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