• Réka Gustafson, S Ellen Demlow, Afshan Nathoo, Geoffrey McKee, Lauren E MacDonald, Tianxin Chu, Jat Sandhu, Eric Grafstein, Mark Hull, Dean Chittock, Ronald Carere, Mel Krajden, Christopher H Sherlock, Scott Harrison, Christopher S Buchner, MontanerJulio S GJSGBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; University of British Columbia, Department of Medicine, Vancouver, Canada., and Patricia Daly.
• Vancouver Coastal Health, Communicable Disease Control, Vancouver, BC, Canada; University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada.
• Prev Med. 2020 Aug 1; 137: 106132.

AbstractEarly treatment of HIV infection increases life expectancy and reduces infectivity; however, delayed HIV diagnosis remains common. Implementation and sustainability of hospital-based routine HIV testing in Vancouver, British Columbia, was evaluated to address a local HIV epidemic by facilitating earlier diagnosis and treatment. Public health issued a recommendation in 2011 to offer HIV testing to all patients presenting to three Vancouver hospitals as part of routine care, including all patients admitted to medical/surgical units with expansion to emergency departments (ED). We evaluated acceptability, feasibility, and effectiveness from 2011 to 2014 and continued monitoring through 2016 for sustainability. Between October 2011-December 2016, 114,803 HIV tests were administered at the three hospitals; an 11-fold increase following implementation of routine testing. The rate of testing was sustained and remained high through 2018. Of those tested, 151 patients were diagnosed with HIV for a testing yield of 0.13%. Review of 12,996 charts demonstrated 4935/5876 (96·9%) of admitted patients agreed to have an HIV test when offered. People diagnosed in hospital were significantly more likely to be diagnosed with acute stage (aOR 1·96, 95% CI 1·19, 3·23) infection, particularly those diagnosed in the ED. This study provides practice-based evidence of the feasibility, acceptability, and effectiveness of implementing a recommendation for routine HIV testing among inpatient and emergency department admissions, as well as the ability to normalize and sustain this change. Routine hospital-based HIV testing can increase diagnoses of acute HIV infection and facilitate earlier initiation of antiretroviral treatment.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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