AID  Vol.2 No.2 , June 2012
Routine Screening for HIV Infection in a Low Risk Population
Abstract: Context: Despite advances in therapy for HIV infection, treatment is often compromised by delayed diagnosis. Strate-gies are needed to improve broad based testing in all medical settings. Objective: To compare HIV screening rates in a primary care setting following implementation of an electronic reminder system to rates produced solely by provider educational efforts. Design: Prospective, observational study of HIV screening, comparing rates during implementation of strategies. Setting: Multiple clinic healthcare system affiliated with a tertiary care medical center. Patients: Veterans receiving care in the clinics affiliated with the Department of Veterans Affairs-Eastern Colorado Healthcare System. Intervention: Provider education and a provider clinical reminder system embedded in the electronic medical record. Main Outcome Measure: Proportion of primary care clinic appointments at which the veteran was screened for HIV infection. Results: The proportion of visits at which screening occurred increased from 2.7% during the provider edu-cation period to 16.7% during the provider clinical reminder period (p < 0.0001). All of the cases identified by the re-minder were antiretroviral therapy candidates, and there was a trend to earlier diagnosis in the screening group than in the diagnostic testing group (CD4 count 329 vs. 109, p = 0.13). Conclusions: An electronic clinical reminder system in a primary care setting is an effective strategy to increase testing for HIV infection, and may lead to fewer delayed diag-noses.
Cite this paper: M. Bessesen, P. Stamper, J. Shaw, N. Ojha, A. Currans, D. Weinshenker and D. Merrick, "Routine Screening for HIV Infection in a Low Risk Population," Advances in Infectious Diseases, Vol. 2 No. 2, 2012, pp. 19-24. doi: 10.4236/aid.2012.22004.

[1]   N. Lohse, A. B. Hansen, G. Pedersen, et al., “Survival of Persons with and without HIV Infection in Denmark, 1995-2005,” Annals of Internal Medicine, Vol. 146, No. 2, 2007, pp. 87-95.

[2]   J. S. Haukoos, E. Hopkins, A. A. Conroy, et al., “Routine Opt-Out Rapid HIV Screening and Detection of HIV Infection in Emergency Department Patients,” Journal of the American Medical Association, Vol. 304, No. 3, 2010, pp. 284-292. doi:10.1001/jama.2010.953

[3]   Centers for Disease Control and Prevention, “Vital Signs: HIV Testing and Diagnosis among Adults—United States, 2001-2009,” Morbidity & Mortality Weekly Report, Vol. 59, No. 47, 2010, pp. 1550-1555.

[4]   G. Marks, N. Crepaz and R. S. Janssen, “Estimating Sexual Transmission of HIV from Persons Aware and Unaware That They Are Infected with the Virus in the USA,” AIDS, Vol. 20, No. 10, 1920, pp. 1447-1450.

[5]   J. Castilla, J. Del Romero, V. Hernando, B. Marincovich, S. Garcia and C. Rodriguez, “Effectiveness of Highly Active Antiretroviral Therapy in Reducing Heterosexual Transmission of HIV,” Journal of Acquired Immune Deficiency Syndromes, Vol. 40, No. 1, 2005, pp. 96-101. doi:10.1097/01.qai.0000157389.78374.45

[6]   Centers for Disease Control and Prevention, HIV Surveillance Report 21, 2010. http://

[7]   B. M. Branson, H. H. Handsfield, M. A. Lampe, et al., “Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings,” Morbidity & Mortality Weekly Report Recommendations & Reports, Vol. 55, No. RR-14, 2006, pp. 1-17.

[8]   R. C. Merchant, G. R. Seage, K. H. Mayer, M. A. Clark, V. G. DeGruttola and B. M. Becker, “Emergency Department Patient Acceptance of Opt-In, Universal, Rapid HIV Screening,” Public Health Reports, Vol. 123, Suppl. 3, 2008, pp. 27-40.

[9]   S. R. Kendrick, K. A. Kroc, E. Couture and R. A. “Weinstein. Comparison of Point-of-Care Rapid HIV Testing in Three Clinical Venues,” AIDS, Vol. 18, No. 16, 2004, pp. 2208-2210. doi:10.1097/00002030-200411050-00017

[10]   P. M. Marzuk, H. Tierney, K. Tardiff, et al., “Increased Risk of Suicide in Persons with AIDS,” Journal of the American Medical Association, Vol. 259, No. 9, 1988, pp. 1333-1337. doi:10.1001/jama.1988.03720090023028

[11]   T. R. Cote, R. J. Biggar and A. L. Dannenberg, “Risk of Suicide among persons with AIDS,” Journal of the American Medical Association, Vol. 268, No. 15, 1992, pp. 2066-2068. doi:10.1001/jama.1992.03490150118035

[12]   A. L. Dannenberg, J. G. McNeil, J. F. Brundage and R. Brookmeyer, “Suicide and HIV Infection. Mortality Follow-Up of 4147 HIV-Seropositive Military Service Applicants,” Journal of the American Medical Association, Vol. 276, No. 21, 1996, pp. 1743-1746.

[13]   G. D. Sanders, A. M. Bayoumi, V. Sundaram, et al., “Cost-Effectiveness of Screening for HIV in the Era of Highly Active Antiretroviral Therapy,” New England Journal of Medicine, Vol. 352, No. 6, 2005, pp. 570-585. doi:10.1056/NEJMsa042657

[14]   N. Segnan, C. Senore, B. Andreoni, et al., “Randomized Trial of Different Screening Strategies for Colorectal Cancer: Patient Response and Detection Rates,” Journal of the National Cancer Institute, Vol. 97, No. 5, 2005, pp. 347-357. doi:10.1093/jnci/dji050

[15]   M. B. Goetz, T. Hoang, C. Bowman, et al., “A System-Wide Intervention to Improve HIV Testing in the Veterans Health Administration,” Journal of General Internal Medicine, Vol. 23, No. 8, 2008, pp. 1200-1207. doi:10.1007/s11606-008-0637-6

[16]   F. Ketema, C. Zeh, D. C. Edelman, R. Saville and N. T. Constantine, “Assessment of the Performance of a Rapid, Lateral Flow Assay for the Detection of Antibodies to HIV,” Journal of Acquired Immune Deficiency Syndromes, Vol. 27, No. 1, 2001, pp. 63-70. doi:10.1097/00126334-200105010-00011

[17]   Abbott Laboratories, “HIVAB HIV-1/HIV-2 (rDNA) EIA Package Insert,” 2011. BloodBloodPrducts/ApprovedProducts/LicensedProducts BLAs/BloodDonorScreening/InfectiousDisease/UCM091153.pdf