The Alameda County Medical Center (ACMC) proposes to implement a 24-month demonstration program designed to produce a practical, cost-effective, and fully replicable model for incorporating opt-out rapid HIV testing into the setting of a busy urban emergency department (ED). The proposed intervention will build upon the successes of an existing Centers for Disease Control and Prevention-funded demonstration in which ACMC has implemented an opt-in HIV screening program within its ED. Since January 2005, this program has tested over 6,000 ED patients with an overall positivity rate of 1.3%, and has convincingly demonstrated that patients are highly receptive to HIV testing when it is offered in a manner that does not single out or stigmatize specific behaviors or lifestyles. The program will utilize two full-time, bilingual HIV testers to administer rapid HIV tests within the triage areas of the ACMC Emergency and Urgent Care Departments during regular business hours. Nursing personnel will administer rapid tests at the bedside and in examination rooms during night and weekend hours. All patients testing positive will be counseled by trained ED staff and directly linked to HIV specialty care. During an 18-month demonstration period, the program will administer at least 28,000 confidential rapid HIV tests resulting in the identification and linkage to care of approximately 187 newly-diagnosed HIV-positive individuals. The vast majority of the HIV-positive patients will be low-income persons of color who would not otherwise have sought HIV testing. In terms of public health impact, demonstrating the feasibility and acceptance of opt-out HIV testing will lead to dramatic increases in HIV testing rates by making HIV testing a routine part of health care and by eliminating major barriers inherent with traditional testing protocols. The success of this project will pave the way for major changes in national policy that will destigmatize HIV testing, making it an accepted, accessible, and standardized health care intervention. ? ? ? ?
| Haukoos, Jason S; White, Douglas A E; Lyons, Michael S et al. (2011) Operational methods of HIV testing in emergency departments: a systematic review. Ann Emerg Med 58:S96-103 |
| White, Douglas A E; Tran, Tony; Dideum, Patrick J et al. (2011) Physician-initiated rapid HIV testing in an urban emergency department: comparison of testing using a point-of-care versus a laboratory model. Ann Emerg Med 58:S53-9 |
| White, Douglas A E; Scribner, Alicia N; Vahidnia, Farnaz et al. (2011) HIV screening in an urban emergency department: comparison of screening using an opt-in versus an opt-out approach. Ann Emerg Med 58:S89-95 |
