Routine rapid HIV testing in hospitals: Another opportunity for hospitalists to improve care

Abstract

The Centers for Disease Control and Prevention recommends routinely offering HIV testing to inpatients at hospitals with an HIV seroprevalence rate of greater than 1% or an AIDS diagnosis rate of greater than 1.0 per 1000 discharges. This recommendation has not been widely adopted, perhaps because of one of several barriers: the cost of implementing a counseling and testing program; the logistics of HIV counseling and testing on a hospital ward particularly with respect to privacy; concern about the follow-up of HIV test results necessitating patients to return after discharge; and the cultural mindset of screening as an outpatient modality complicated by the fear of raising the possibility of HIV testing and therefore eliciting a negative reaction from a patient who has not requested it. This article focuses on these barriers and some possible solutions, emphasizing the role of FDA-approved rapid HIV tests, which may decrease follow-up issues for HIV testing programs. It also considers hospitalists, given their frontline status and ability to coordinate the multidisciplinary services and system-wide approach required to implement such a program, as leaders in this area.