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Popul Health Manag. 2018 Feb;21(1):40-45. doi: 10.1089/pop.2017.0012. Epub 2017 Jun 13.

Results and Implications of Routine HIV Testing in the Inpatient Setting: A Descriptive Analysis.

Author information

1
1 JACQUES Initiative, Institute of Human Virology, University of Maryland School of Medicine , Baltimore, Maryland.
2
2 Division of Medicine, Surgery and Cardiovascular Medicine, University of Maryland Medical Center , Baltimore, Maryland.
3
3 Department of Quality and Safety, University of Maryland Medical Center, University of Maryland School of Nursing , Baltimore, Maryland.
4
4 University of Maryland Medical Center , Baltimore, Maryland.
5
5 Clinical Division, Institute of Human Virology, University of Maryland School of Medicine , Baltimore, Maryland.
6
6 University of Maryland Medical Center, University of Maryland School of Medicine , Baltimore, Maryland.

Abstract

Policy changes and scientific advances have guided new methods of diagnosing and managing HIV that reduce mortality, morbidity, and transmission. In a high HIV prevalence urban setting, a hospital initiative was implemented to routinely perform HIV testing and provide linkage to care for those with positive results and for individuals with a prior diagnosis of HIV. Maryland's unique all-payer model presents an opportunity to implement population health initiatives in health systems. The rationale, methodology, results and lessons learned from this approach will be discussed. Providers and nurses offered routine HIV screening and activated a Linkage to Care Navigator (LCN) for all HIV positive patients. The LCN provided referrals to HIV care and supportive services. In 22 months, 28 persons were newly diagnosed with HIV. Eighty-two percent (n = 23) were linked to outpatient care; 28.6% (8) were readmitted within 30 days for an inpatient stay. Of 517 patients previously diagnosed with HIV, 27.7% (n = 143) were not engaged in outpatient HIV care. Nearly 50% of those (n = 71) were relinked to care. Of 143 patients with a previous diagnosis who were considered out of care at the time of inpatient admission, 16 (11.2%) were readmitted as an inpatient within 30 days. Routinizing HIV testing and linkage to care in an inpatient setting identifies new and previously diagnosed HIV infected individuals who are not in care. This process has potential to identify HIV earlier, lower community viral load, and decrease transmission of HIV.

KEYWORDS:

HIV testing; linkage to care; population health; readmissions

PMID:
28609229
DOI:
10.1089/pop.2017.0012
[Indexed for MEDLINE]

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