In the fall of 2006, Howard University Hospital began planning an HIV screening program based on CDC guidelines that call for testing all patients ages 13-64. In the District, there are 128.4 AIDS cases per 100,000 people. Howard's outreach targeted people ages 14-84.
Of some 20,000 people offered screening, about 13,000 consented to take the 20-minute oral HIV antibody test, which yielded about 260 positives.
Dr. Celia Maxwell, the hospital's assistant vice president for health sciences, was tasked with implementing the program with the assistance of the city health department and CDC. Maxwell first needed the support of the hospital's division chiefs and chairs, who were concerned about stretching staff thin by testing so many patients. The rapid test had to be approved by pathology, and a Clinical Laboratory Improvement Amendments waiver had to be obtained.
In addition, many insurers do not cover HIV tests given under a universal testing scenario, though it is recommended by CDC, the American Medical Association, and other medical societies. "If I didn't get the [testing] kits from the D.C. Department of Health, I could not do it," Maxwell said. "If I did not get staff that is funded through the CDC, I couldn't do it." Grants will likely remain necessary for program sustainability.
Confidential screening is offered to emergency room patients and inpatients, while anonymous testing is offered to clinic patients and other outpatients. A mobile testing van also offers anonymous tests to hospital staff.
One lesson learned in the process is to ensure patients who tested presumptively HIV-positive on the oral test received a confirmatory Western blot test before leaving the hospital, Maxwell said. "We lost about 80 people" who missed a follow-up appointment for the Western blot, though 70 of the patients were later tracked down, she said.
06/23/08
D.C. Hospital Starts All-Inclusive HIV Screening
Source: American Medical News:: Susan J. Landers; Courtesy of the CDC National Center for HIV, STD, and TB Prevention