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

BACKGROUND: 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.
PURPOSE: 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. (c) 2006 Society of Hospital Medicine.