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Expanded HIV Testing Strategy Leveraging the Electronic Medical Record Uncovers Undiagnosed Infection Among Hospitalized Patients

Felsen, Uriel R. MD, MPH, MS*; Cunningham, Chinazo O. MD, MS*; Heo, Moonseong PhD; Futterman, Donna C. MD; Weiss, Jeffrey M. MD*; Zingman, Barry S. MD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2017 - Volume 75 - Issue 1 - p 27–34
doi: 10.1097/QAI.0000000000001299
Implementation Science

Background: Routine HIV testing of hospitalized patients is recommended, but few strategies to expand testing in the hospital setting have been described. We assessed the impact of an electronic medical record (EMR) prompt on HIV testing for hospitalized patients.

Methods: We performed a pre–post study at 3 hospitals in the Bronx, NY. We compared the proportion of admissions of patients 21–64 years old with an HIV test performed, characteristics of patients tested, and rate of new HIV diagnoses made by screening while an EMR prompt recommending HIV testing was inactive vs. active. The prompt appeared for patients with no previous HIV test or a high-risk diagnosis after their last HIV test.

Results: Among 36,610 admissions while the prompt was inactive, 9.5% had an HIV test performed. Among 18,943 admissions while the prompt was active, 21.8% had an HIV test performed. Admission while the prompt was active was associated with increased HIV testing among total admissions [adjusted odds ratio (aOR) 2.78, 95% confidence interval (CI): 2.62 to 2.96], those without a previous HIV test (aOR 4.03, 95% CI: 3.70 to 4.40), and those with a previous negative test (aOR 1.52, 95% CI: 1.37 to 1.68) (P < 0.0001 for all). Although the prompt was active, testing increased across all patient characteristics. New HIV diagnoses made by screening increased from 8.2/100,000 admissions to 37.0/100,000 admissions while the prompt was inactive and active, respectively (OR 4.51 95% CI: 1.17 to 17.45, P = 0.03).

Conclusions: An EMR prompt for hospitalized patients was associated with a large increase in HIV testing, a diversification of patients tested, and an increase in diagnoses made by screening.

Supplemental Digital Content is Available in the Text.

*Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY;

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; and

Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.

Correspondence to: Uriel R. Felsen, MD, MPH, MS, Montefiore Medical Center, AIDS Center, 111 E 210th Street, Bronx, NY 10467 (e-mail:

Supported in part by the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center (NIH AI-51519); NIH/NCATS UL1TR001073; NIH R25DA023021; NIH K24DA036955; K23MH106386; HRSA U10HA29291; Gilead FOCUS Program for Scaling up HIV Testing; and by the New York City Department of Health and Mental Hygiene HIV though a contract with Public Health solutions (13-SLC-165).

Paper presented at IDWeek 2016; October 29, 2016, New Orleans, LA.

B.S.Z. has received research grants from Cepheid to evaluate HIV viral load assays, as well as from Gilead to study antiretroviral agents. D.C.F. has received unrestricted educational and clinical trial grants from Gilead. However, none of this funding is related to the work presented in this manuscript. The remaining authors have no conflicts of interest to disclose.

Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the funders.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received June 01, 2016

Accepted January 17, 2017

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