Background The CDC recommends universal and routine

HIV screening in all healthcare settings, including hospitals [MMWR 52(15), 329-332; 2003].

The CDC funds rapid HIV testing programs in public health departments and some community-based organizations (CBOs) and hospitals in the U.S.

The current scope of rapid HIV testing in non-public health funded venues, such as non-public hospitals, in the U.S. is unknown.

The present study aimed to determine the scope of rapid HIV testing in a national probability sample of hospitals in the U.S.

Methods

Telephone surveys in 2005 with 584 hospitals.

Three PMSAs randomly selected from each U.S. Region:

Northeast: Boston, NY, Newark

Midwest: Chicago, Indianapolis, St. Louis

South: Atlanta, Miami, Washington, DC

West: Los Angeles-Long Beach, Oakland, Riverside-San Bernardino

The probability of sampling a PMSA was proportional to the size of its AIDS patient population.

Laboratory staff were asked if the hospital used rapid HIV tests, and if so, the settings and start date of use.

Hospital service area and hospital characteristics were compiled from the census and American Hospital Association database.

Results

Summary & Conclusions Rapid HIV testing is increasing in U.S. hospitals,

but it is primarily used after occupational exposure and is rarely used for patient screening.

Larger hospitals were more likely to be providing rapid HIV tests, most likely because of their greater resources with which to initiate and sustain rapid testing programs.

Hospitals, labor and delivery units, and emergency departments/urgent care centers in areas of higher AIDS prevalence were more likely to be using rapid HIV tests, possibly due to their greater need for HIV testing.

Hospitals in the Western region (i.e., three PMSAs sampled in CA) were less likely to be using rapid HIV tests than were hospitals in other U.S. regions. The more stringent regulatory environment of California for rapid HIV tests likely contributed to the lower levels of use.

Policies should be developed to encourage greater breadth of diffusion of rapid HIV testing.

Rapid dissemination of results would especially improve care and reach higher-risk populations in emergency departments, and in labor and delivery.

Scope of Rapid HIV Testing in Hospitals across the United States Laura M. Bogart, PhD,1 James V. Lange, PhD,2 Devery Howerton, PhD,2 Kirsten Becker, MPH,1

Allen Gifford, MD,3 Claude Messan Setodji, PhD,1 & Steven Asch, MD1,4 1RAND Corporation; 2Laboratory Practice Evaluation and Genomics Branch, Centers for Disease Control and Prevention

3VA QUERI-HIV Coordinating Center, VA San Diego Healthcare System; 4Dept. of General Internal Medicine, Greater Los Angeles VA Healthcare System

Acknowledgments

The authors thank RAND’s Survey Research Group for conducting the interviews and members of the study’s advisory board for their feedback

Supported by Grant U65/CCU924523 5 from the Centers for Disease Control and Prevention

Presented at the American Public Health Association Annual Meeting, November, 2006, Boston, MA

For further information, contact:

Laura M. Bogart, PhD, RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138E-mail: lbogart@rand.org

Multivariate Predictors of Rapid HIV Test Use in Hospitals across the United States (OR, 95%CI)

52 50

29

13

0

10

20

30

40

50

60

OverallOcc HlthL&DED/UC

Cumulative Percentage of Rapid HIV Test Use in Hospitals, 2002-2006

0

10

20

30

40

50

60

70

late 2002 2003 2004 2005 early 2006(projected)

Occ Hlth= Occupational Health; L&D = Labor & Delivery; ED/UC = Emergency Department/Urgent Care

Notes: OR = odds ratios; 95%CI = 95% confidence intervals; + p < .10, * p < .05, ** p < .01, *** p < .001; Reference group for region= West (CA)

Rapid HIV Test Use in Hospital(N=584)

Rapid HIV Test Use in OCC Hlth (N = 584)

Rapid HIV Test Use in ED/UC (N = 498) Rapid HIV Test Use in L&D(N=360)

Geographic Region Northeast 1.45 (0.95, 2.22)+ 1.54 (1.01, 2.35)* 1.47 (0.72, 2.98) 3.05 (1.52, 6.15)** South 5.83 (3.75, 9.06)*** 6.36 (4.10, 9.88)*** 1.84 (0.91, 3.72)+ 1.80 (0.89, 3.62) Midwest 3.87 (2.62, 5.72)*** 2.70 (1.84, 3.97)*** 3.49 (1.87, 6.50)*** 23.91 (12.17, 46.98)***Hospital Service Area % African American 0.99 (0.98, 1.00)* 0.99 (0.98, 1.00) 1.01 (1.00, 1.02) 1.01 (0.98, 1.03) % Latino 0.97 (0.96, 0.98)*** 0.98 (0.97, 0.99)*** 1.00 (0.97, 1.01) 0.98 (0.98, 1.02) % Living in Poverty 1.04 (1.01, 1.08)* 1.03 (1.00, 1.06)+ 0.99 (0.95, 1.04) 1.00 (0.96, 1.05)Hospital Size AIDS Prevalence 1.29 (1.08, 1.55)** 1.01 (0.84, 1.20) 1.34 (1.04, 1.73)* 2.93 (2.26, 3.81)*** Ave. Daily Census 2.47 (2.16, 2.82)*** 2.41 (2.11, 2.75)*** 1.13 (0.87, 1.46) 1.19 (0.88, 1.60) ED Visits/Year __ __ 1.59 (1.20, 2.12)** __

Percentage of Hospitals and Hospital Departments Using Rapid HIV Tests

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