Patient Risks, Outcomes, and Costs of Voluntary HIV Testing at Five Testing Sites Within a Medical Center

Public Health Rep. 2008 Sep-Oct; 123(5): 608–617.

PMCID: PMC2496934

Patient Risks, Outcomes, and Costs of Voluntary HIV Testing at Five Testing Sites Within a Medical Center

Supriya D. Mehta, PhD, MHS,^a Jonathan Hall, MM, LADC-1,^b Jeffrey L. Greenwald, MD,^c Kevin Cranston, MD,^d and Paul R. Skolnik, MD^b^e

^aDepartment of Epidemiology and Biostatistics, University of Illinois Chicago, Chicago, IL

^bDepartment of Medicine, Center for HIV/AIDS Care and Research, Boston Medical Center, Boston, MA

^cHospital Medicine Unit, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA

^dHIV/AIDS Bureau, Massachusetts Department of Public Health, Boston, MA

^eDivision of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA

Address correspondence to: Supriya D. Mehta, PhD, MHS, Department of Epidemiology and Biostatistics, University of Illinois, 958 SPHPI, M/C 923, 1603 W. Taylor St., Chicago, IL 60612, Phone: 312-413-7485, Fax: 312-996-0064, ; Email: supriyad/at/uic.edu

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SYNOPSIS

Objectives.

The Centers for Disease Control and Prevention (CDC) recommends offering human immunodeficiency virus (HIV) testing to all patients in all high HIV-prevalence clinical settings. We evaluated programmatic aspects of HIV testing across multiple clinical settings within a single medical center.

Methods.

We analyzed programmatic data of HIV testing in the Urgent Care Center (UCC), inpatient floors, outpatient primary care, a non-clinical Drop-In Center, and Emergency Department (ED). HIV testing was by oral mucosal transudate, venous blood samples, or rapid testing fingersticks, with Western blot confirmation. We compared the sociodemographics and behavioral risks of individuals undergoing HIV testing across the five sites and estimated costs per person tested and per HIV-positive test result.

Results.

From 2002 to 2004, 16,750 HIV tests were conducted, with 229 (1.4%) previously unreported HIV infections diagnosed among 16,696 valid test results. HIV-positive prevalence was 1.5% for the UCC, 1.5% at the Drop-In Center, 1.4% for primary care, 1.2% for inpatient, and 0.6% in the ED. Behavioral risks were most prevalent in the UCC and the Drop-In Center. The cost per test was lowest in the UCC and highest in the Drop-In Center. The cost per previously unreported HIV infection was lowest in the UCC ($1,980) and highest in the ED ($9,724).

Conclusions.

Although a significant number of HIV infections were identified, the number of tests performed represents <10% of all clinical visits. Due to personnel and time constraints, offering HIV testing to patients hierarchically in some settings of a high-volume medical center merits evaluation.

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