Routine Human Immunodeficiency Virus Research Articles

Measuring Sexual Behavior Stigma to Inform Effective HIV Prevention and Treatment Programs for Key Populations.

BackgroundThe levels of coverage of human immunodeficiency virus (HIV) treatment and prevention services needed to change the trajectory of the HIV epidemic among key populations, including gay men and other men who have sex with men (MSM) and sex workers, have consistently been shown to be limited by stigma.ObjectiveThe aim of this study was to propose an agenda for the goals and approaches of a sexual behavior stigma surveillance effort for key populations, with a focus on collecting surveillance data from 4 groups: (1) members of key population groups themselves (regardless of HIV status), (2) people living with HIV (PLHIV) who are also members of key populations, (3) members of nonkey populations, and (4) health workers.MethodsWe discuss strengths and weaknesses of measuring multiple different types of stigma including perceived, anticipated, experienced, perpetrated, internalized, and intersecting stigma as measured among key populations themselves, as well as attitudes or beliefs about key populations as measured among other groups.ResultsWith the increasing recognition of the importance of stigma, consistent and validated stigma metrics for key populations are needed to monitor trends and guide immediate action. Evidence-based stigma interventions may ultimately be the key to overcoming the barriers to coverage and retention in life-saving antiretroviral-based HIV prevention and treatment programs for key populations.ConclusionsMoving forward necessitates the integration of validated stigma scales in routine HIV surveillance efforts, as well as HIV epidemiologic and intervention studies focused on key populations, as a means of tracking progress toward a more efficient and impactful HIV response.

Impact of an Electronic Medical Record-Based System to Promote Human Immunodeficiency Virus/Hepatitis C Virus Screening in Public Hospital Primary Care Clinics.

BackgroundUnited States guidelines recommend that all adolescents and adults be tested for human immunodeficiency virus (HIV) and that persons born between 1945 and 1965 be tested for hepatitis C virus (HCV).MethodsWe used electronic medical record (EMR) data to identify patients in 3 primary care clinics in Seattle, Washington who met national criteria for routine HCV or HIV testing and had no documented history of prior testing. Clinic staff received daily lists of untested patients with scheduled appointments. We used generalized linear models to compare the percentage of patients tested and newly diagnosed with HIV and HCV in the 18 months before and during the intervention.ResultsA total of 16784 patients aged 18–64 and 9370 patients born between 1945 and 1965 received care from January 2011 to December 2015. Comparing the preintervention and intervention periods, the percentage of previously untested patients tested for HIV and HCV increased from 14.9% to 30.8% and from 18.0% to 35.5%, respectively (P < .0001 for both). Despite this increase in testing, there was no change in the percentage of patients newly diagnosed with HIV (0.7% in both periods, P = .96) or HCV (3.6% vs 3.7%, P = .81). We estimate that 1.2%–15% of HCV-infected primary care patients in our medical center are undiagnosed.ConclusionsEMR-based HCV/HIV testing promotion increased testing but not case finding among primary care patients in our medical center. In our institution, most HCV-infected patients are already diagnosed, primarily through risk-based and clinical screening, highlighting the need to concentrate future efforts on increasing HCV treatment.

Seroprevalence of HIV Infection and Associated Factors Among Newly Incarcerated Prisoners in Abidjan, Ivory Coast

Poor socio-economic condition of prisoners and practices at risk of getting transmissible diseases in most prisons contribute to the spread of Human Immunodeficiency Virus (HIV) infection. The objectives of this study were to determine HIV seroprevalence among newly incarcerated persons, to describe their risk behaviors, and to identify factors associated with HIV infection. We conducted a cross-sectional study from January 2014 to February 2014 at the biggest prison of Abidjan called “House of Judgement and Correction of Abidjan” (HJCA). Study population included newly incarcerated persons aged more than 18 years. Overall, 370 people were included after an informed consent. Findings showed that 13% of inmates used drug; 8.3% of them using injectable drugs. The vast majority of respondents (97.3%) experienced sexual intercourse and 31.9% had multiple sexual partners. More than half (50.6%) of respondents did not use condom, and among those who use it, 73.6% used it irregularly. During their last sexual intercourse, 71.8% of respondents did not use condom. Overall, 7.9% of respondents were HIV positive. Factors associated with HIV positive status were history of herpes zoster (adj. OR=16.66, 95% CI: 2.66-104.08, p=0.003), history of STIs (adj. OR=8.82, 95% CI: 3.25-23.95, p<0.001), history of tuberculosis (adj. OR=6.49, 95% CI: 1.06-39.79, p=0.043), and having had more than one sexual partner over the last 12 months (adj. OR=8.11, 95% CI: 1.75-37.51, p=0.007). Promoting safer behaviors, routine HIV screening among prisoners, care for HIV-positive people, and improved living conditions in prisons are needed measures to control HIV / AIDS in prison environment in Ivory Coast.

Prevalence and Clinical Characteristics of Gastroesophageal Reflux Disease in Human Immunodeficiency Virus–Infected Adults

Background Gastroesophageal reflux disease (GERD) is common in the general population, but its burden is unknown in human immunodeficiency virus (HIV)–infected adults. The primary objective of the study was to determine the prevalence and clinical characteristics of GERD in HIV-infected adults. Methods We conducted a cross-sectional study of 85 HIV-infected adults from 2 HIV clinics in Canada. The patients completed a validated GERD questionnaire during their scheduled clinic visits. Results Eighty-five HIV-infected adults were included in the analysis. Mean age, median body mass index, and median waist circumference were 44 years, 25 cm, and 93 cm, respectively. Sixty-eight patients (81%) had GERD, and 52 (77%) of them were male. Of the 68 adults with GERD, 36 (52.9%) were classified as frequent, and 42 (61.8%) were classified as moderate-severe. Twenty-two patients had metabolic syndrome, of whom 19 (86.4%) had GERD symptoms. The weight of patients with GERD was higher than that in patients without GERD (75 [interquartile range, 19.5] and 63.35 [interquartile range, 19.8] kg, respectively; P = 0.04). Sixty-five patients (95.6%) who had GERD symptoms were taking medications to treat it. Most patients (92.3%) were on histamine-2 receptor antagonists. Conclusions Gastroesophageal reflux disease is prevalent among HIV-infected adults, and more than half of the patients present with symptoms described as frequent and/or moderate-severe in intensity. The screening and management of GERD are important considerations as part of routine HIV care.

Knowledge, attitude, and practices of dental students toward human immunodeficiency virus/acquired immunodeficiency syndrome of AMC Dental College and Hospital, Ahmedabad, Gujarat: A cross-sectional study

Aims: This study aimed to evaluate the knowledge and awareness of the dental students regarding human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) and HIV testing in routine dental practice. Materials and Methods: It is a cross-sectional survey, in which 267 students from 3rd year, 4th year, and interns of B.D.S at AMC Dental College and Hospital participated voluntarily. A close-ended questionnaire with multiple-choice questions was designed for this survey. Chi-square test was used for statistical analysis using SPSS version 20 software. Results: In this study, we found that >90% of the participants have overall adequate knowledge about HIV/AIDS, there were inadequacies in terms of testing, treatment, and therapy. The participants showed positive attitude toward people living with HIV/AIDS (PLWHAs), but the results also indicate that the dental students are not well equipped to treat HIV/AIDS patients though sympathetic. One of the key findings is that >80% of students are in favor of using rapid HIV testing in clinical setup as screening test. Conclusion: Dental students must be made aware of and should understand the importance of treating HIV/AIDS patients. This can be achieved by proper modeling and making the students more sensitized toward PLWHAs as well as introduction of routine HIV testing kits at dental setups.

Ocular surface squamous neoplasia as the initial presenting sign of human immunodeficiency virus infection in 60 Asian Indian patients.

To study the importance of routine human immunodeficiency virus (HIV) screening in patients with ocular surface squamous neoplasia (OSSN) and describe their clinical features and management. Retrospective study. Of 228 cases of OSSN screened for HIV by enzyme-linked immunosorbent assay, 86 (38%) patients were HIV positive. Of these 86 patients, 60 (70%) were unaware of their HIV-positive status prior to HIV screening. These 60 (26%) patients with newly detected HIV-positive status were included in this study. Ocular surface squamous neoplasia was the sole presenting feature of HIV infection in these patients. Mean age at presentation was 41years. Bilateral involvement occurred in 9 (15%) cases. The mean tumor basal diameter was 11mm. Orbital involvement was noted in 6 (9%) cases, and intraocular tumor extension occurred in 1 (1%) case. Based on American Joint Committee Classification, T2 (n=35, 51%) was most common. The primary treatment for OSSN included excision biopsy (n=52, 75%), topical chemotherapy with Mitomycin-C (n=5, 7%), extended enucleation (n=4, 6%), and orbital exenteration (n=8, 12%). Tumor recurrence occurred in 23% cases during a mean follow-up period of 9months. On histopathology, invasive squamous cell carcinoma was more common (n=38, 55%). OSSN was the presenting sign of underlying HIV infection in 26% cases, and 70% were unaware of their HIV-positive status prior to HIV screening. In this study, T2 tumor was most common, and 26% cases required extended enucleation/orbital exenteration to achieve complete tumor resection.

How Underestimates of Need Contribute to Biased Conclusions.

How Underestimates of Need Contribute to Biased Conclusions.

HIV Testing and Outcomes Among Hispanics/Latinos - United States, Puerto Rico, and U.S. Virgin Islands, 2014.

The 2015 National HIV/AIDS Strategy provides an updated plan to address health disparities in communities at high risk for human immunodeficiency virus (HIV) infection (1,2). Hispanics/Latinos* are disproportionately affected by HIV in the United States. In 2014, 23% of HIV diagnoses were among Hispanics/Latinos, who represented 16% of the U.S. population (3). To examine HIV testing services, CDC analyzed 2014 data from the National HIV Prevention Program Monitoring and Evaluation (NHM&E) system submitted by 60 CDC-funded health departments† and 151 community-based organizations. Among Hispanics/Latinos tested, gay, bisexual, and other men who have sex with men (MSM) had the highest percentage of HIV diagnoses (2%). MSM accounted for 19.8% of HIV test events conducted among Hispanics/Latinos and 63.8% of Hispanics/Latinos who received an HIV diagnosis in non-health care settings.§ Approximately 60% of Hispanics/Latinos who received an HIV diagnosis were linked to HIV medical care within 90 days; this percentage was lower in the South than in other U.S. Census regions. HIV prevention programs that are focused on expanding routine HIV screening and targeting and improving linkage to medical care and other services (e.g., partner services) for Hispanics/Latinos can help identify undiagnosed HIV cases and reduce HIV transmission.

Full House: A Retrospective Analysis of High Sexually Transmitted Infection Prevalence among Adult Film Actors at a Singular Residence.

During a routine human immunodeficiency virus (HIV) investigation, Florida Department of Health staff identified a house (house A) in which over 150 individuals had resided at least briefly. Further investigation revealed that house A is used by the producer of a small adult film production company to board his actors. This report describes sexually transmitted infection (STI) prevalence among male actors in gay adult films residing in a common Florida residence. LexisNexis Accurint was used to identify house A residents since October 2002 when the producer arrived. Information on STIs and interview data were obtained from Florida's STI surveillance system. An infection was considered to be associated with residence in house A if the date of diagnosis occurred 6 months before an individual's residence start date through 6 months after his residence end date. Excluding the producer, 150 men resided in house A starting from September 2003 to July 2015. Forty-six individuals had a reported case of HIV, syphilis, gonorrhea, and/or chlamydia with 92 infections total. Forty-two (46%) infections among 24 men were considered associated with residence in house A. LexisNexis Accurint was a useful tool for identifying house A residents, a highly mobile and highly sexually active population. There is a high prevalence of STIs among residents, but it is unclear where transmission is occurring. Settings like house A are good candidates for HIV pre-exposure prophylaxis and active STI screenings and may be an opportunity for public health officials to intervene in high-risk groups to reduce STI rates in the community.

A qualitative exploration of health workers' and clients' perceptions of barriers to completing four antenatal care visits in Morogoro Region, Tanzania.

Antenatal care (ANC) remains an important contact point on the continuum of care for mothers and children in low- and middle-income countries. In Tanzania, the proportion of pregnant women completing at least four ANC visits (ANC-4) dropped from 70% to 43% between 1999 and 2010. To identify potential causes of the decline in the number of ANC visits, we conducted qualitative research at 18 health centres in Morogoro Region, exploring providers' communication about ANC visits and clients' and providers' perceptions of changes in ANC services and barriers to completing four visits. We also observed counselling messages delivered during 203 ANC consultations. Our results indicate that provider communication about ANC visit recommendations is inadequate, and confusion exists among clients about when and how often they should attend. Participants highlighted how the scale up of Prevention of Mother-to-Child Transmission, with routine human immunodeficiency virus testing for women and their male partners, presents additional barriers for some women. Changes to the timing and content of ANC services following the adoption of the Focused ANC model was described by participants as changing women's perceptions and decisions in how they utilize ANC services. In particular, condensed delivery of technical interventions fostered a sense among clients that multiple visits are unnecessary. Other barriers that may contribute to declining ANC-4 include changing norms about family planning and birth spacing, out-of-pocket costs for clients and informal practices adopted by health facilities and providers such as turning women away who attend early in pregnancy or are not accompanied by male partners. Further research is needed to determine the role and extent that these barriers may be contributing to declining ANC-4. Issues of poor communication, supply inadequacies and informal practices, deserve immediate attention from the health system.

Tuberculosis and HIV co-infection in Vietnam.

Tuberculosis (TB) and human immunodeficiency virus (HIV) infection are leading causes of disease and death in Vietnam, but TB/HIV disease trends and the profile of co-infected patients are poorly described. We examined national TB and HIV notification data to provide a geographic overview and describe relevant disease trends within Vietnam. We also compared the demographic and clinical profiles of TB patients with and without HIV infection. During the past 10 years (2005-2014) cumulative HIV case numbers and deaths increased to 298,151 and 71,332 respectively, but access to antiretroviral therapy (ART) improved and new infections and deaths declined. From 2011-2014 routine HIV testing of TB patients increased from 58.9% to 72.5% and of all TB patients diagnosed with HIV in 2014, 2,803 (72.4%) received ART. The number of multidrug resistant (MDR)-TB cases enrolled for treatment increased almost 3-fold (578 to 1,532) from 2011-2014. The rate of HIV co-infection in MDR and non-MDR TB cases (51/1,532; 3.3% vs 3,774/100,555; 3.8%; OR 0.77, 95% CI 0.7-1.2) was similar in 2014. The care of TB/HIV co-infected patients have shown sustained improvement in Vietnam. Rising numbers of MDR-TB cases is a concern, but this is not "driven" by HIV co-infection.

Disclosure of Sexual Orientation and Uptake of HIV Testing and Hepatitis Vaccination for Rural Men Who Have Sex With Men.

The decision and ability of primary care clinician to make recommendations for routine human immunodeficiency virus (HIV) testing and hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccines are shaped by knowledge of their patient's risk behaviors. For men who have sex with men, such knowledge requires disclosure of same-sex sexual behavior or sexual identity. Data were analyzed from a national survey of rural men who have sex with men (N = 319) to understand whether the disclosure of sexual identity to clinicians was associated with increased uptake of HIV testing and hepatitis vaccinations. We found that disclosure of sexual identity to clinicians was significantly associated (OR = 1.26; 95% CI, 1.08-1.47) with uptake of routine HIV testing and HAV/HBV vaccination. Our finding reinforces the need for safe, nonjudgmental settings for patients to discuss their sexual identities freely with their clinicians.

Careful Conversations and Careful Sex: HIV Posttesting Experiences Among African American Men in Rural Florida.

In the United States, black/African American (black) men bear the greatest burden of human immunodeficiency virus (HIV), accounting for 42% of new HIV infections in 2012 despite being 6% of the population. In Florida, heterosexual HIV transmission has increased among black men. Few studies have examined HIV testing experiences for black heterosexual men (BHM) in the rural South. This study describes the post-HIV-testing trial experiences of BHM in rural Florida. We conducted 12 focus groups (4-7 participants per group) in 3 rural Florida counties with BHM who participated in a larger randomized HIV testing trial. Interviews were professionally transcribed and data were analyzed using NVivo 10. The qualitative analysis was informed by the strengths perspective (ie, emphasis on abilities rather than risks) and used a thematic analytical approach. Sixty-seven men participated (median age 41.5 years); 39 (58%) earned a monthly income of less than $500, 38 (57%) attained education through high school or higher, 37 (55%) were unmarried, and 40 (60%) reported practicing monogamy; all who tested for HIV were negative for HIV. We identified 3 main themes based on self-reported actions: (1) risk reduction (eg, more consistent condom use, fewer sex partners), (2) sexual health communications with sex partners (eg, negotiating HIV testing with sex partners, getting to know partners better), and (3) health communications with peers and family (eg, disclosing test results, encouraging others to get tested). Among BHM, being in this HIV testing study facilitated increased protective behaviors and communications for HIV prevention. Interventions for BHM in rural areas warrant incorporating these strategies to encourage routine HIV testing.

Third-world realities in a first-world setting: A study of the HIV/AIDS-related conditions and risk behaviors of sex trade workers in Saskatoon, Saskatchewan, Canada

The transmission and prevalence of Human Immunodeficiency Virus (HIV) among those employed as sex trade workers (STW) is a major public health concern. The present study describes the self-reported responses of 340 STW, at-risk for contracting HIV. The participants were recruited by selective targeting between 2009 and 2010 from within the Saskatoon Health Region (SHR), Saskatchewan, Canada. As of 2012, the SHR has the highest incidence rate of positive test reports for HIV in Canada, at more than three times the national average (17.0 vs. 5.9 per 100,000 people). Additionally, the epidemiology of HIV/AIDS in the SHR is different from that seen elsewhere in Canada (still mostly men having sex with men and Caucasians), with its new HIV cases predominantly associated with injection drug use and Aboriginal cultural status. The purpose of this study was to (a) describe the demographic and socio-economic characteristics of the STW in the SHR, (b) identify their significant life events, self-reported problems, knowledge, attitudes, behaviors, self-efficacy, and barriers regarding HIV, and (c) determine the significant independent risk indicators for STW self-reporting a chance of greater than 50% of becoming infected with HIV/AIDS. The majority of the study participants were females, who were never married, of Aboriginal descent, without a high school diploma, and had an annual income of less than $10,000. Using multivariate regression analysis, four significant independent risk indicators were associated with STW reporting a greater that 50% chance of acquiring HIV/AIDS, including experiencing sexual assault as a child, injecting drugs in the past four weeks, being homeless, and a previous Chlamydia diagnosis. These findings provide important evidence of the essential sexual and drug-related vulnerabilities associated with the risk of HIV infection among STW and offer insight into the design and implementation of effective and culturally sensitive public health intervention and prevention efforts. To be most effective, it is recommended that such intervention and prevention initiatives: (1) use specifically tailored community-based outreach to high risk STW who are drug users and link them with appropriate drug treatment and HIV/AIDS prevention and treatment services, (2) provide free and confidential, routine HIV counseling and testing in substance abuse programs, and (3) build capacity among the local, Aboriginal NGOs so as to address with cultural sensitivity both the drug and HIV-related risk factors prevalent among this vulnerable population.

Introducing routine HIV screening for patients on an internal medicine residency inpatient service: a quality improvement project

The US Centers for Disease Control and Prevention (CDC) recommend human immunodeficiency virus (HIV) screening for all persons aged 13 to 64 years who present to a health care provider....

Real-World Costs of Implementing Routine Human Immunodeficiency Virus Screening and Linkage to Care

Real-World Costs of Implementing Routine Human Immunodeficiency Virus Screening and Linkage to Care

Patients' understanding of blood tests and attitudes to HIV screening in the emergency department of a Swiss teaching hospital: a cross-sectional observational study.

In Switzerland, patients may undergo "blood tests" without being informed what these are screening for. Inadequate doctor-patient communication may result in patient misunderstanding. We examined what patients in the emergency department (ED) believed they had been screened for and explored their attitudes to routine (non-targeted) human immunodeficiency virus (HIV) screening. Between 1st October 2012 and 28th February 2013, a questionnaire-based survey was conducted among patients aged 16-70 years old presenting to the ED of Lausanne University Hospital. Patients were asked: (1) if they believed they had been screened for HIV; (2) if they agreed in principle to routine HIV screening and (3) if they agreed to be HIV tested during their current ED visit. Of 466 eligible patients, 411 (88%) agreed to participate. Mean age was 46 ± 16 years; 192 patients (47%) were women; 366 (89%) were Swiss or European; 113 (27%) believed they had been screened for HIV, the proportion increasing with age (p ≤ 0.01), 297 (72%) agreed in principle with routine HIV testing in the ED, and 138 patients (34%) agreed to be HIV tested during their current ED visit. In this ED population, 27% believed incorrectly they had been screened for HIV. Over 70% agreed in principle with routine HIV testing and 34% agreed to be tested during their current visit. These results demonstrate willingness among patients concerning routine HIV testing in the ED and highlight a need for improved doctor-patient communication about what a blood test specifically screens for.

Enhanced syphilis screening among HIV-positive men (ESSAHM): a study protocol for a clinic-randomized trial with stepped wedge design.

BackgroundThe current syphilis epidemic among urban men who have sex with men (MSM) has serious implications for those co-infected with human immunodeficiency virus (HIV). Routine and frequent syphilis screening has the potential to ensure early detection and treatment, minimize disease burden, and help control the ongoing spread of syphilis and HIV. We aim to enhance syphilis screening among HIV-positive men by conducting a clinic-based intervention that incorporates opt-out syphilis testing into routine HIV laboratory evaluation for this population. Trial objectives are to determine the degree to which the intervention (1) increases the detection rate of untreated syphilis, (2) increases screening coverage, (3) increases screening frequency, and (4) reaches men at highest risk according to sexual behaviors.Methods/designThe trial is a pragmatic, stepped wedge cluster-randomized controlled trial that introduces the intervention stepwise across four urban HIV clinics in Ontario, Canada. The intervention includes standing orders for syphilis serological testing whenever a male in HIV care undergoes HIV viral load testing, which typically occurs every 3–6 months. The control condition is the maintenance of current, provider-initiated syphilis testing practice. Approximately 3100 HIV-positive men will be followed over 30 months. Test results will be obtained from the centralized provincial laboratory in Ontario and will be supplemented by a standardized clinical worksheet and medical chart review at the clinics. Detailed clinical, psychosocial, and behavioral data is available for a subset of men receiving HIV care who are also participants of the province-wide Ontario HIV Treatment Network Cohort Study. Process evaluation plans include audit and feedback of compliance of the participating centers to identify potential barriers to the introduction of this type of practice into routine care. Health economic components include evaluation of the impact and cost-effectiveness of the intervention.DiscussionThis trial will be the first of its kind in Canada and will provide evidence regarding the feasibility, clinical effectiveness, and cost-effectiveness of a clinic-based intervention to improve syphilis screening among HIV-positive men. Involvement of knowledge users in all stages of trial design, conduct, and analysis will facilitate scale-up should the intervention be effective.Trial RegistrationClinicalTrials.gov NCT02019043

Survey of Attitudes and Practices of Osteopathic Primary Care Physicians Regarding Taking of Sexual Histories and HIV Screening.

an estimated 252,000 to 312,000 individuals have undiagnosed human immunodeficiency virus (HIV) infection in the United States. To date, little has been known about osteopathic physicians' attitudes and practices regarding routine HIV testing. to understand osteopathic primary care physicians' attitudes and practices toward HIV testing and sexual history taking and to examine factors associated with osteopathic physicians' recommendations of HIV testing at the initial patient visit. a cross-sectional survey of osteopathic physicians was conducted at the 106th Annual Convention of the Florida Osteopathic Medical Association in February 2009. Survey participants were asked 36 questions about osteopathic physician and patient sociodemographic factors and osteopathic physician attitudes and office practices regarding HIV testing and sexual history taking. a total of 233 osteopathic physicians completed the survey, but only 160 respondents (69%) met inclusion criteria of working in primary care and spending more than 50% of their time with patients. Almost two-thirds of participants were men, 80% were white, and the age range was 28 to 83 years. Twenty-two percent of participants recommended HIV testing at the initial patient visit, and 18% recommended annual HIV testing for all patients. Eighty-seven percent obtained a separate consent form for HIV testing, and 19% included HIV testing in general consent forms. About two-thirds of participants recommended annual HIV testing for homosexual men. Three factors were associated with recommending HIV testing at the initial patient visit: (1) recommending an annual HIV test for sexually active patients (odds ratio [OR], 12.82; 95% confidence interval [CI], 3.97-41.67); (2) having an agree/strongly agree attitude toward HIV testing (OR, 5.59; 95% CI, 1.63-19.23); and (3) obtaining a general consent form that included permission for HIV testing (OR, 3.25; 95% CI, 1.07-9.90). osteopathic physicians who practice primary care medicine can play a crucial role in reducing the number of individuals with undiagnosed HIV infection. More concerted efforts are needed to help osteopathic physicians incorporate HIV testing as part of routine care for all patients.

Using a configurable EMR and decision support tools to promote process integration for routine HIV screening in the emergency department.

Given the clinical and public health benefits of routine Human Immunodeficiency Virus (HIV) testing in the emergency department (ED) and Centers for Disease Control and Prevention recommendations, Maricopa Medical Center, as part of Maricopa Integrated Health System, started Test, Educate, Support, and Treat Arizona (TESTAZ) and became the first and, to-date, only hospital in Arizona to implement routine, non-targeted, opt-out, rapid HIV screening in the ED. The authors describe the implementation of a universal, routine, opt-out HIV screening program in the adult ED of an urban safety-net hospital serving under-served populations, including the uninsured and under-insured. Through a controlled and collaborative process, the authors integrated custom documentation elements specific to HIV screening into the triage/intake process, implemented and utilized clinical decision support tools to guide clinicians in each step of the process, and used electronic data collection and reporting to drive new screening protocols that led to a significant increase in overall HIV testing rates.