Experience from Croydon University Hospital in south London shows that HIV screening for new hospital admissions can work. Although this policy is recommended for areas of high HIV prevalence, not all hospitals have implemented it.
The Acute Medical Unit (part of the hospital’s emergency services) started offering opt-out HIV testing to adult patients in 2011. Just over 4000 patients were tested during a 21-month period – representing one third of patients admitted to the unit.
Twenty people were diagnosed with HIV during this time. This amounts to a prevalence of around 0.5% in those tested (similar to the prevalence in the local community). HIV testing is usually thought to be cost-effective if 0.1% or more people test positive.
A third of the diagnoses would have been missed if only people with clinical indicator diseases had been tested.
In high-prevalence areas, more widespread implementation of opt-out testing in acute settings could make an important contribution to reducing the levels of undiagnosed infection and late diagnosis. The Croydon findings show that the testing policy is acceptable, feasible, sustainable and cost-effective.
The researchers attribute the success of the policy to close support during the early stages from members of the hospital’s HIV team, ownership of the policy by Acute Medical Unit staff (despite high staff turnover), and the enthusiasm of nurses, who eventually took the lead in implementing the policy.