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Routine voluntary HIV testing of all hospital patients could identify a substantial number of patients with undiagnosed HIV

Testing only high-risk or symptomatic patients for the human immunodeficiency virus (HIV) that causes AIDS is inadequate to identify the one-third of HIV-positive people in the United States (300,000) who are unaware of their HIV infection, according to the results of a new pilot study. Researchers implemented the Think HIV program and found that use of routine, voluntary HIV testing in all patients admitted to Boston Medical Center—which has a 1 percent prevalence of HIV infection among its patients—tripled the likelihood that patients would undergo HIV testing compared with patients admitted prior to the Think HIV program.

Using this testing approach in 72 hospitals nationwide that have patient demographics similar to Boston Medical Center (and assuming a similar HIV prevalence at these hospitals) would identify an additional 8,000 to 31,800 HIV-infected patients per year compared with current strategies to test only high-risk or symptomatic patients, according to the researchers who conducted the study. In the routine Think HIV program, 6.4 percent of admitted patients underwent testing and counseling for HIV. The program detected about two new diagnoses of HIV infection per month compared with one per month during the 15 months prior to the program.

Patients who underwent testing during the program, who had an estimated prevalence of HIV infection of 3.8 percent, were informed about their infection, counseled, and linked to care and treatment. The researchers estimated that, with about 500 medical admissions at the hospital per month, voluntary testing of all inpatients might detect 19 patients with previously undiagnosed HIV per month compared with the 1.3 patients per month identified by results of targeted testing. Their study was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00020).

More details are in "Identifying undiagnosed human immunodeficiency virus: The yield of routine, voluntary inpatient testing," by Rochelle P. Walensky, M.D., M.P.H., Elena Losina, Ph.D., Kathleeen A. Steger-Craven, R.N., M.P.H., and Kenneth A. Freedberg, M.D., M.Sc., in the April 22, 2002 Archives of Internal Medicine 162, pp. 887-892.

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