Routinely offering HIV testing to all patients admitted to a hospital could reveal many cases that would otherwise go undiagnosed, a study at one US urban hospital suggests. A program of voluntary HIV testing of all inpatients at Boston Medical Center diagnosed roughly two HIV infections per month, compared with one per month before the program began, according to a report in the Archives of Internal Medicine (April 22, 2002;162:887-892).

According to the study authors, their program differed from most inpatient HIV testing programs, which target only patients deemed to be at highest risk of HIV infection. They note that 72 hospitals in the United States have demographics similar to those of the study hospital, suggesting that such HIV testing programs could work in many urban medical centers. In a 15-month period before the program, 2 percent of more than 7,000 hospital patients were referred for HIV counseling and testing, the researchers report. During the program, more than 6 percent of patients went for testing. The investigators estimate that among patients who would probably not have undergone HIV testing otherwise, 4 percent were HIV-positive.

According to Dr. Rochelle P. Walensky of Harvard Medical School, who led the study, an estimated one-third of HIV-infected Americans have not undergone testing. And many individuals who do get tested are already late in the course of the disease, resulting in missed opportunities for treatment and prevention, the authors noted. "This study can serve as an example for other facilities to establish similar screening efforts so that most of the estimated 300,000 people with undiagnosed HIV infection in the United States can be identified and provided with appropriate care."

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