We have worked extensively with Barts Health NHS Trust in London, promoting HIV testing in several contexts across their hospitals, especially the Royal London. That’s why we’re particularly interested in an item of short correspondence appearing in this week’s Lancet. Based around opt-out testing for all patients in critical care, it’s a fascinating piece of work from Barts and John Thornhill, Gerlinde Mandersloot, Rachel Bath, an PI Chloe Orkin.
We introduced a universal opt-out HIV testing initiative in the adult critical care unit to increase diagnosis in critically ill patients and reduce morbidity and mortality in a high prevalence setting (local prevalence is 6·25 per 1000 individuals).5 We off ered opt-out HIV testing to all nonelective patients admitted to the adult critical care unit and patients unable to consent were tested under a best interests principle on the basis of the high local HIV prevalence.
For the first 6 months (from October, 2012, to April, 2013) of the initiative: 465 (52%) of 899 adults admitted to the critical care unit had an HIV test (46 percentage points higher than in the 6 month period before the initiative when the testing rate was 6%, p<0·01). Three patients tested HIV-positive, giving a diagnosed HIV prevalence rate in the adult critical care unit of 6 per 1000 individuals— consistent with local prevalence (6·25 per 1000 individuals) and suggesting that routine testing is highly relevant in this setting. All three patients were discharged from hospital on highly active antiretroviral therapy (HAART).
The full article is available in the Lancet.