A total of 1,230 hospitals participated in this survey, which represented about 27% of all nonfederal general hospitals in the U.S. at that time (n=4,497). The majority of respondents were professionals in infection control (43%) or the laboratory (25%). Characteristics of this sample generally reflected the population of U.S. hospitals; however, the distribution of respondent hospitals differed significantly from nonrespondent hospitals relative to three variables: ownership, MSA type, and census region (). Sixty-six percent of respondent hospitals were nonprofit, 26% were government, and 9% were for profit. The distribution among nonrespondents was 61% nonprofit, 24% government, and 15% for profit. Among respondent hospitals, 28% were in large metropolitan areas, 18% in medium areas, 9% in small areas, and 45% in non-metropolitan areas. These figures compare with 32% of nonrespondents in large metropolitan areas, 16% in medium areas, 8% in small areas, and 44% in non-metropolitan areas. Finally, 19% of respondent hospitals were in the Northeast census region, 34% in the Midwest, 32% in the South, and 15% in the West, while 12% of nonrespondent hospitals were in the Northeast, 28% in the Midwest, 40% in the South, and 20% in the West.
Selected characteristics of U.S. hospitals by total population, HIV testing survey respondents, and nonrespondentsa
Most sample hospitals had EDs (88%), outpatient centers (70%), and L&D units (69%). One-third had trauma centers and one-quarter had urgent care centers.
Availability of HIV testing in hospitals
Ninety-one percent of responding hospitals offered HIV testing (on the basis of clinical symptoms or risk factors). A majority had HIV testing available in at least one of the following settings: inpatient (62%), employee health (58%), and ED (57%). HIV testing was also available in L&D (49%) and outpatient settings (43%). HIV testing was not commonly available in urgent care centers (27%) or trauma centers (16%).
depicts the prevalence of HIV testing by hospital characteristics and location. HIV testing was available in 100% of teaching hospitals, 97% of hospitals in the Northeast, 96% of hospitals in large MSAs, and 97% of large hospitals. Hospitals' teaching status (p<0.001), regional location (p=0.004), size (p<0.001), and type of metropolitan area (p<0.001) were associated with the availability of HIV testing. Hospital ownership (public, nonprofit, or for profit) was not associated with HIV testing (p=0.320).
Prevalence of HIV testing and screening in U.S. hospitals by selected hospital characteristics and location
Results related to rapid-test use are not included, as they have been reported elsewhere.27–30
Availability of HIV screening in hospitals
While HIV testing was available in most responding hospitals, less than one-quarter (23%) reported screening patients for HIV regardless of location within the hospital. L&D was the most common, with 18% of hospitals reporting they screen patients there. Screening of inpatient, outpatient, or ED patients was rare; none of these occurred in more than 2% of hospitals.
also depicts the prevalence of HIV screening by hospital characteristics and location. The patterns are similar to what was observed for HIV testing, but at much lower levels. HIV screening was offered in 34% of teaching facilities, 28% of large hospitals, 29% of large MSAs, and 35% of Northeastern hospitals. Teaching status (p<0.001), size (p<0.001), census region (p<0.001), and type of metropolitan area (p=0.008) were associated with HIV screening in hospitals; hospital ownership was not (p=0.070).
Common reasons for HIV testing in hospitals
The most common indications considered for HIV testing included health-care workers after an occupational exposure (92%), clinicians' concern because of acquired immunodeficiency syndrome (AIDS) symptoms (84%) or risk factors (80%), or patients who requested an HIV test (71%). Treatment of rape victims was an indication in two-thirds of hospitals (68%); HIV tests were indicated for pregnant women in more than half of the hospitals (59%). The least commonly considered indication was when patients were being evaluated for sexually transmitted diseases (STDs) (39%).
Personnel for HIV testing
In hospitals that offered HIV testing, mainly physicians ordered tests (94%), administered pretest procedures such as counseling and consent (70%), and delivered test results to patients (80% when the test was negative, 85% when the test was positive). Nurses also figured prominently, primarily in administering pretest procedures (62%). In some hospitals, they ordered tests (39%), drew specimens (35%), and delivered test results (40% when negative, 28% when positive). In some hospitals, physicians' assistants ordered tests (30%). In others, trained counselors administered pretest procedures (14%) and delivered results (11% when negative, 9% when positive). Social workers and members of the HIV clinical team were rarely involved in any aspect of HIV testing in hospitals.
Written consent policy in hospitals
Eighty-eight percent of hospitals that offered HIV tests required patients to sign written consents. Ninety-one percent of those that obtained written consent reported it was hospital policy to do so (). Two-thirds, with regional variation (p<0.001), indicated that obtaining written consent was state law. For example, more Northeastern hospitals cited state law requirements than any other region; the South was the least likely to cite state law. Few hospitals reported that consent was required by local law (6%) or at clinician discretion (2%).
Consent policies for HIV testing in U.S. hospitals by total and census regiona,b
Medical evaluation for patients who test positive
shows where hospitals refer patients for medical evaluation and follow-up after a positive HIV test. Forty-two percent referred patients to a community-based clinic that was not affiliated with the hospital for medical evaluation. Thirty-six percent referred patients to a hospital-based clinic/outpatient center, and 35% provided an on-site medical evaluation the same day the positive result was disclosed. Referrals to hospital-based clinics were more common among hospitals in the Northeast (45%) and Midwest (41%). Hospitals in the South were more likely to refer patients to community-based clinics (50%). The least common practice was setting an appointment for an on-site medical evaluation at a later date (15%).
Where patients who test positive for HIV in the hospital receive medical evaluation, by total and census regiona,b
Availability of other HIV services
shows the availability of HIV services in addition to testing. At least 80% of hospitals that offered HIV tests directly provided or had arrangements with other facilities to deliver primary HIV care services, social services, and HIV counseling services to HIV-positive patients. These services tended to be -provided by the hospitals themselves rather than through referral arrangements with other facilities, such as community-based, public health, and other provider organizations.
Availability of other HIV services in U.S. hospitalsa,b
Approximately three-quarters of hospitals provided case management and drug and alcohol treatment. Two-thirds provided partner notification and referral services and infectious diseases specialists. These services were mostly provided through referral arrangements. Case management was equally likely to be available on-site or through referral.