Experiences in implementation of routine human immunodeficiency virus testing in a US tuberculosis clinic

SETTING: Rhode Island Tuberculosis (RI TB) Clinic, The Miriam Hospital, Providence, RI, USA. BACKGROUND: Human immunodeficiency virus (HIV) status is a critical factor in the management of both patients with latent TB infection (LTBI) and active TB. Since 2006, the Centers for Disease Control and Prevention has recommended routine, opt-out HIV testing in all health care settings, including TB clinics. However, implementation of HIV testing in LTBI patients has been limited. DESIGN: A policy for HIV assessment of all new patients was instituted at the RI TB Clinic. Patients who reported no HIV testing in the preceding year were offered 1 opt-out HIV testing. Patient records (June 2010 June 2011) were retrospectively reviewed. Structured nursing interviews assessed staff acceptance. RESULTS: A total of 821 (77.5%) first-visit TB patients underwent HIV status assessment: 96.3% of those not tested in the previous year agreed to testing; 65.9% of tests were performed at point of care. There was one new HIV diagnosis. CONCLUSION: Implementing routine opt-out HIV testing in the RI TB Clinic is feasible, with high staff acceptance rates and low patient refusal rates. Perceived health systems barriers can be overcome. Incorporating opt-out HIV testing for LTBI patients expands testing opportunities to individuals unaware of their HIV status, and can identify HIV-infected patients early in the course of infection.