BRONX, NY - December 18, 2013 – As of November 2013, all patients seen in the Moses Emergency Department are routinely offered HIV testing.
"This is a first step toward implementing the routine offer of HIV testing at all Montefiore Medical Center Emergency Department and inpatient sites," said Dr. Uriel Felsen, Medical Director for HIV Testing at the Montefiore AIDS Center. "Similar systems at the other Montefiore sites are planned for the upcoming months."
According to the Department of Health and Human Services, despite great progress in the diagnosis and treatment of HIV/AIDS, many people remain unaware that they are infected with the disease until late in its progression. Though increased HIV testing may speed diagnosis, get patients treated sooner, increase chances of long-term survival, and reduce spread of the disease, many clinicians still do not routinely offer the test to sexually active patients.
The routine testing initiative was made possible through the cooperation of the AIDS Center, the Adolescent AIDS Program, Emergency Health Information Technology (EHIT), the Emergency Department, the Department of Pathology, and Einstein/Montefiore Department of Medicine leadership, in an effort to adhere to guidelines supporting routine HIV testing and the New York State Public Health law mandating its offer. In September 2010, New York became the first state requiring hospitals and primary care providers to offer HIV testing to all patients between the ages of 13 and 64 years. The law also streamlined the consent process, including allowing oral consent for rapid HIV testing.
As part of this initiative, HIV testing is routinely offered by Emergency Department nursing staff to all patients who have not been tested in the past year, are not known to be HIV positive, are clinically stable, and have the capacity to consent. AIDS Center HIV counselor/testers administer oral swabs to patients in the Emergency Department fast-track (Green Zone). All other consenting patients receive blood tests.
Because all HIV tests performed in the Emergency Department (oral swabs and blood tests alike) are processed on rapid platforms, they have an approximate turnaround time of less than 24 hours and are considered to be "rapid tests." Therefore, Emergency Department staff only obtains verbal consent from patients; separate written consent is not required. Montefiore AIDS Center staff members follow up on all tests performed and assist patients who are newly identified as HIV positive in getting appropriate medical care and support services.
Since its inception when AIDS was first identified in the 1980s, the Montefiore AIDS Center has led the field of multispecialty, multidisciplinary HIV/AIDS care, with innovative advancement of fellowship training, research collaboration, and expert hands-on patient care in the hospital and specialty clinics. Dr. Barry Zingman, Director of the AIDS Center, recently collaborated in a study finding that targeting HIV-infected cells with radioimmunotherapy could potentially eradicate the virus.
Through the routine offering of HIV testing, the AIDS Center hopes to achieve individual benefits by diagnosing patients at an earlier stage of the disease and aggressively linking them to care, as well as public health benefits by interrupting transmission of the virus from those who are unaware of their HIV-positive status.
"As the largest provider of care in the Bronx, one of the epicenters of the domestic HIV epidemic, Montefiore has long been a leader in HIV treatment and prevention," said Dr. Felsen. "The formal implementation of this expanded HIV testing strategy reflects our ongoing commitment to using the best available evidence to combat the epidemic."