Background Opt out testing for HIV in our hospital's acute medical unit (AMU) had been successfully piloted between August 2009 and September 2010. Our trust was selected a pilot site to implement the 2008 national HIV testing guidelines as an area of high HIV prevalence outside London. (Data from this pilot were presented at BASHH in Gateshead in 2010). However, could opt out testing for HIV on an AMU be sustained beyond the pilot?
Methods HIV testing in the pilot was embedded into the normal working of the AMU, clinical aides did the phlebotomy, medical admission proformas were modified to include HIV testing and consent was obtained by a widely distributed information leaflet. One of the GU consultants attended the AMU to remind doctors to test several times a week. After the pilot finished, the GU consultant stopped attending the ward HIV testing is now part of routine care on the AMU. It is explained at each junior doctors induction which includes a patient video. Electronic blood test requests for AMU automatically include an HIV test as part of the AMU blood bundle set. A CQUIN target that 25% of all admissions are to be tested for HIV has been set by commissioners. Testing has been expanded from the 16–60 age range to the 16–80 age range.
Results The rate of HIV testing has risen from 80 a month to 140 a month in 2011 the number of new +ves diagnosed has risen from 10 per year to 25 in 2011
Conclusion Sustainable opt out testing for HIV on an AMU can be achieved by embedding the testing process in the clinical pathways that already exist upon an AMU. This requires no extra manpower or resources to achieve within an AMU setting. Since the withdrawal of consultant support our average testing rate has gone up. Our model for opt out HIV testing is therefore sustainable, requires little extra resource and should be easy to reproduce in other centres.