Journal of AIDS & Clinical Research

Rapid Routine HIV Testing for Psychiatric Inpatients

Abstract

Maryann J. Popiel, Vikram Duvvi, Albert Turkieh, Ethan Cowan, Yvette Calderon, Christian Umfrid, Kelly M. Chacón, Julia Krauss, Anuj Rao, Jennifer Zahn, Uttara Gadde and Jason Leider

The Centers for Disease Control and Prevention recommends that HIV screening be routine and offered in all healthcare settings, including all mental health care facilities. The psychiatric patient population is known to be at higher risk and have significantly higher prevalence of HIV infection than the general population, but remains inconsistently tested and often missed through screening efforts. The objective of this study was to implement and determine the efficacy of a counselor-based HIV screening program on inpatient psychiatric units, and to identify risk factors and barriers to testing within this population. Utilizing dedicated, trained Public Health Advocates, rapid HIV testing was offered to a convenience sample of psychiatric inpatients determined to have capacity to consent. Pre-test counseling was provided and demographic and risk factor data obtained from participants, while reasons for refusal were obtained from those who denied testing. Of consentable patients, 74.6% were offered testing and 62.9% of offers were accepted, resulting in 405 patients tested and one new HIV diagnosis. Amongst those who were tested, 26.4% were found to be high-risk, 33.1% had a history of drug use and 7.4% had a history of sex abuse, while 38% did not receive regular medical care and 22.2% had never been tested for HIV. The most common reason for patients rejecting testing was the belief that they were not at risk (44%). In sum, many psychiatric inpatients were high-risk for HIV infection but did not receive regular health care, and personal risk perception is the major barrier preventing patients from obtaining testing. Counselor-based rapid testing proved to be acceptable to psychiatric inpatients and an effective model for screening a large number of high-risk and underserved individuals with minimal added burden to the mental health care team.