CLINICAL SCIENCE Better But Not Ideal Acceptance of Routine Inpatient HIV Point-of-Care Testing Among Veterans in a High Prevalence Area Marc Siegel, MD,*† Leigh Kennedy, MD,*† Karen Rexroth, BS,* Margaret Lankford, NP,* Melissa Turner, MSW,* Angela McKnight, APRN-BC,* Shirley Cummins, BS,* Debra Benator, MD,*† and Virginia Kan, MD*† Background: The most recent guidance statement from The American College of Physicians recommends that clinicians adopt human immunodeficiency virus screening as part of routine medical care. Inpatient HIV testing at the Vetarns Affairs Medical Center in Washington, DC has been predominantly targeted at patients with disclosed risk factors. Method: We implemented the first voluntary inpatient HIV testing program within a Veterans Affairs hospital using the OraQuick Advance Rapid HIV-1/2 Antibody Test on both oral secretion and whole blood samples. Results: During a 17 month period we offered 3,467 inpatients testing and performed 824 rapid HIV tests. All reactive results were Western blot confirmed. Ten patients (1.2%) had reactive test results. Seven (0.8%) represented new HIV diagnoses, and three had been previously diagnosed outside the VA. Five patients had AIDS at the time of testing by CD4 criteria. Nine patients were linked to care and six patients were started on antiretroviral therapy. There were no false- positive results. Conclusion: We have demonstrated how expanding HIV-POC testing among hospitalized patients can enhance patients’ acceptance for screening, can detect HIV-infected individuals who might not have been tested with conventional targeted testing, and can improve linkage to care for those with HIV infection. Key Words: routine inpatient HIV testing, inpatient point-of-care HIV testing, rapid HIV testing (J Acquir Immune Defic Syndr 2010;55:205–210) INTRODUCTION Within the United States, 1.4 million people were estimated to have HIV infection in 2007, 1 and an estimated 21%–27% of infected persons were unaware of their diagnosis. 2,3 Alarmingly, in 2008, the estimate of cases of HIV/AIDS in the United States was increased from approximately 40,000 annual new infections since 1998 2 to a new estimate of 56,300 new infections in 2006, 1 of which about 17,280 cases were thought to be due to transmission from persons unaware of their HIV status. 4 Among new cases from 1994 to 1999, the Centers for Disease Control (CDC) has shown that 41% will develop AIDS within a year of their diagnosis. 5 The CDC revised its recommendations in 2006 for HIV screening to be performed routinely for all patients aged 13–64 years, unless the prevalence of undiagnosed HIV infection in the community is below 0.1%. 6 The American College of Physicians published their guidance statement in January 2009 for clinicians to adopt HIV screening as part of routine medical care, to encourage patients to be tested, and to determine the need for repeat screening on an individual patient basis. 7 The first rapid HIV-1 antibody test kit was approved by the Food and Drug Administration in November 2002. There are currently 6 rapid test kits for HIV screening, providing results within 30 minutes. The use of rapid HIV antibody tests facilitates patients being informed of their screening results during their initial encounter 8 and, in some settings, has resulted in an increased linkage to medical care for those with reactive screening tests. 9 In 2009, District of Columbia (DC) had the highest per capita rate of HIV in the United States estimated at 3.2% of the population more than age 12 years. 10 The Veterans Affairs Medical Center in Washington, District Columbia (VAMC-DC), is a 158-bed acute tertiary care medical center providing emergency, hospital, and ambulatory care to more than 44,000 veterans in the metropolitan Washington, DC, area. Until now, inpatient HIV testing at the VAMC-DC had been predominantly targeted to patients with disclosed risk factors. We implemented a voluntary rapid HIV testing in several inpatient settings within the VAMC-DC and evaluated patient acceptance of rapid HIV testing, the percentage of patients with reactive screening tests, the prevalence of new HIV infections among those tested, and the rate of linkages to care. Received for publication December 18, 2009; accepted April 3, 2010. From the *Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC; and †Division of Infectious Diseases, The George Washington University Medical Center, Washington, DC. The views expressed in this article are those of the authors and do not reflect the policies of the Department of Veterans Affairs or George Washington University. Potential Financial Conflicts of Interest: None by any of the authors. Correspondence to: Marc Siegel, MD, Division of Infectious Disease, The George Washington University Medical Center, Washington, DC 20037 (e-mail: msiegel@mfa.gwu.edu). Copyright Ó 2010 by Lippincott Williams & Wilkins J Acquir Immune Defic Syndr  Volume 55, Number 2, October 1, 2010 www.jaids.com | 205