The present study examined the scope of rapid human immunodeficiency virus (HIV) testing in urban U.S. hospitals.
Methods.
In a multistage national probability sample, 12 primary metropolitan statistical areas (three per region) were sampled randomly, with weights proportionate to acquired immunodeficiency syndrome (AIDS) populations. All 671 eligible hospitals within areas were selected. Laboratory staff from 584 hospitals (87%) were interviewed by telephone in 2005.
Results.
About 52% reported rapid HIV test availability (50% in occupational health, 29% in labor and delivery, and 13% in emergency department/urgent care), and 86% of hospitals offering rapid tests processed them in the laboratory. In multivariate models, rapid test availability was more likely in hospitals serving more patients, and located in high-poverty, high-AIDS prevalence areas, and in the South or Midwest vs. West. It was less likely in hospitals serving areas with large percentages of people who were black/African American or Hispanic/Latino (p<0.05).
Conclusions.
Rapid HIV testing is increasing across urban U.S. hospitals, primarily for occupational exposure and in hospitals with greater resources and need. To achieve routine HIV screening, policies should encourage greater breadth of diffusion of rapid testing at the point of care, especially in smaller facilities, the West, and communities with racial/ethnic diversity.
References
1.
BransonBMHandsfieldHHLampeMAJanssenRSTaylorAWLyssSB, Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep2006 (RR-14);55:1–17.
2.
HIV and AIDS—United States, 1981–2001. MMWR Morb Mortal Wkly Rep2001; 50(21):430–4.
3.
Centers for Disease Control and Prevention (US). Advancing HIV prevention: Interim technical guidance for selected interventions. 2003.
4.
WeinhardtLSCareyMPJohnsonBTBickhamNL. Effects of HIV counseling and testing on sexual risk behavior: A meta-analytic review of published research, 1985 −1997. Am J Public Health 1999; 89:1397–405.
5.
Revised guidelines for HIV counseling, testing, and referral. MMWR Recomm Rep2001; 50(RR-19):1–58.
6.
BulterysMJamiesonDJO'SullivanMJCohenMHMaupinRNesheimS, Rapid HIV-1 testing during labor: A multicenter study. JAMA2004; 292:219–23.
7.
DelaneyKPBransonBMUniyalAKerndtPRKeenanPAJafaK, Performance of an oral fluid rapid HIV-1/2 test: Experience from four CDC studies. AIDS2006; 20:1655–60.
8.
WesolowskiLGMacKellarDAFacenteSNDowlingTEthridgeSFZhuJH, Post-marketing surveillance of OraQuick whole blood and oral fluid rapid HIV testing. AIDS2006; 20:1661–6.
9.
GreenwaldJLBursteinGRPincusJBransonB.A rapid review of rapid HIV antibody tests. Curr Infect Dis Rep2006; 8:125–31.
10.
Chembio Diagnostic Systems Inc.HIV 1/2 STAT-PAK™ Assay. Package Insert. Medford (NY): Chembio Diagnostic Systems Inc.; 2006.
Notice to readers: Protocols for confirmation of reactive rapid HIV tests. MMWR Morb Mortal Wkly Rep2004; 53(10):221–2.
14.
KasslerWJDillonBAHaleyCJonesWKGoldmanA.On-site, rapid HIV testing with same-day results and counseling. AIDS1997; 11:1045–51.
15.
HutchinsonABCorbie-SmithGThomasSBMohananSDel RioC.Understanding the patient's perspective on rapid and routine HIV testing in an inner-city urgent care center. AIDS Educ Prev2004; 16:101–14.
16.
HutchinsonABBransonBMKimAFarnhamPG. A meta-analysis of the effectiveness of alternative HIV counseling and testing methods to increase knowledge of HIV status. AIDS2006; 20:1597–604.
17.
LandrumMLWilsonCHPerriLPHannibalSLO'ConnellRJ. Usefulness of a rapid human immunodeficiency virus-1 antibody test for the management of occupational exposure to blood and body fluid. Infect Control Hosp Epidemiol2005; 26:768–74.
18.
LubelchekRKrocKHotaBShariefRMuppudiUPulvirentiJ, The role of rapid vs. conventional human immunodeficiency virus testing for inpatients: Effects on quality of care. Arch Intern Med2005; 165:1956–60.
19.
KelenGDShahanJBQuinnTC. Emergency department-based HIV screening and counseling: Experience with rapid and standard serologic testing. Ann Emerg Med1999; 33:147–55.
20.
DoyleNMLevisonJEGardnerMO. Rapid HIV versus enzyme-linked immunosorbent assay screening in a low-risk Mexican American population presenting in labor: A cost-effectiveness analysis. Am J Obstet Gynecol2005; 193(3 Pt2):1280–5.
21.
WurcelAZamanTShenSStoneD.Acceptance of HIV antibody testing among inpatients and outpatients at a public health hospital: A study of rapid versus standard testing. AIDS Patient Care STDS2005; 19:499–505.
22.
RobertsKJGruskyOSwansonAN. Outcomes of blood and oral fluid rapid HIV testing: A literature review, 2000 −2006. AIDS Patient Care STDS 2007;21:621–37.
23.
EkwuemeDUPinkertonSDHoltgraveDRBransonBM. Cost comparison of three HIV counseling and testing technologies. Am J Prev Med2003; 25:112–121.
24.
PaltielADWalenskyRPSchackmanBRSeageGR3rdMercincavageLMWeinsteinMC, Expanded HIV screening in the United States: Effect on clinical outcomes, HIV transmission, and costs. Ann Intern Med2006; 145:797–806.
25.
RothmanREKetlogetsweKSDolanTWyerPCKelenGD. Preventive care in the emergency department: Should emergency departments conduct routine HIV screening? A systematic review. Acad Emerg Med2003; 10:278–85.
26.
ACOG Committee on Obstetric Practice. Prenatal and perinatal human immunodeficiency virus testing: Expanded recommendations. Obstet Gynecol2004; 104:1119–24.
27.
ForsythBWBarringerSRWallsTALandryMLFergusonDTinghitellaTJ, Rapid HIV testing of women in labor: Too long a delay. J Acquir Immune Defic Syndr2004; 35:151–4.
28.
Centers for Disease Control and Prevention (US). HIV counseling, testing and referral: Standards and guidelines. 1994.
29.
GuayLAMusokePFlemingTBagendaDAllenMNakabiitoC, Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet1999; 354:795–802.
30.
Rapid point-of-care testing for HIV-1 during labor and delivery—Chicago, Illinois, 2002. MMWR Morb Mortal Wkly Rep2003; 52(36):866–8.
31.
BransonB. Current HIV epidemiology and revised recommendations for HIV testing in health-care settings. J Med Virol2007; 79suppl 1:S6–10.
32.
SibbaldB. New rapid HIV test opens Pandora's box of ethical concerns. CMAJ2000; 162:1600.
33.
GalvanFHBrooksRALeibowitzAA. Rapid HIV testing: Issues in implementation. AIDS Patient Care STDS2004; 18:15–8.
34.
BurkeRCSepkowitzKABernsteinKTKarpatiAMMyersJETsoiBW, Why don't physicians test for HIV? A review of the U.S.literature. AIDS2007; 21:1617–24.
LevensonD. The challenges of universal HIV screening: Why cost, logistics, and some state laws present hurdles to CDC recommendations. Clinical Laboratory News2007 [cited 2007 Nov 1]. Available from: URL: http://www.aacc.org/AACC/publications/cln/2007/oct/cover1_1007.htm
37.
RogersEM. Diffusion of innovations. 5th ed.New York: Free Press; 2003.
38.
FrankelMRShapiroMFDuanNMortonSCBerrySHBrownJA, National probability samples in studies of low-prevalence diseases. Part II: Designing and implementing the HIV cost and services utilization study sample. Health Serv Res1999; 34(5 Pt 1):969–92.
39.
ShapiroMFBerkMLBerrySHEmmonsCAAtheyLAHsiaDC, National probability samples in studies of low-prevalence diseases. Part I: Perspectives and lessons from the HIV cost and services utilization study. Health Serv Res1999; 34(5 Pt 1):951–68.
40.
KishL. Survey sampling. New York: John Wiley and Sons; 1965.
41.
GraubardBIKornEL. Predictive margins with survey data. Biometrics1999; 55:652–9.
42.
JamiesonDJCohenMHMaupinRNesheimSDannerSPLampeMA, Rapid human immunodeficiency virus-1 testing on labor and delivery in 17 U.S. hospitals: the MIRIAD experience. Am J Obstet Gynecol2007; 197(3 Suppl 1):S72–82.
43.
LyonsMSLindsellCJLedyardHKFramePTTrottAT. Emergency department HIV testing and counseling: An ongoing experience in a low-prevalence area. Ann Emerg Med2005; 46:22–8.
44.
LyonsMSLindsellCJLedyardHKFramePTTrottAT. Health department collaboration with emergency departments as a model for public health programs among at-risk populations. Public Health Rep2005; 120:259–65.
45.
RothmanRE. Current Centers for Disease Control and Prevention guidelines for HIV counseling, testing, and referral: Critical role of and a call to action for emergency physicians. Ann Emerg Med2004; 44:31–42.
46.
AndersonJSmithMJKostmanJ.Implementation of a rapid HIV testing program in an inner city hospital emergency department. Paper presented at the XVIth International AIDS Conference; 2006 Oct 13–18; Toronto.
47.
CalderonYLeiderJHailpernSHaugheyMChinRLombardiP, Program B.R.I.E.F.: Video assisted rapid HIV testing in an urban ED. Paper presented at the XVIth International AIDS Conference; 2006 Oct 13–18; Toronto.
48.
Rotheram-BorusMJLeibowitzAAEtzelMA. Routine, rapid HIV testing. AIDS Educ Prev2006; 18:273–80.
49.
KooDJBegierEMHennMHSepkowitzKAKellermanSE. HIV counseling and testing: Less targeting, more testing. Am J Public Health2006; 96:962–4.
50.
SpielbergFBransonBMGoldbaumGMLockhartDKurthARossiniA, Choosing HIV counseling and testing strategies for outreach settings: A randomized trial. J Acquir Immune Defic Syndr2005; 38:348–55.
51.
WalenskyRPLosinaESteger-CravenKAFreedbergKA. Identifying undiagnosed human immunodeficiency virus: The yield of routine, voluntary inpatient testing. Arch Intern Med2002; 162:887–92.
52.
GlynnMRhodesP. Estimated HIV prevalence in the United States at the end of 2003. Paper presented at: National HIV Prevention Conference; 2005 Jun 12–15; Atlanta.
