Routine Opt-Out Screening is Key to Understanding and Identifying HIV/HCV Incidence.

In 2006, the Centers for Disease Control (CDC) recommended routine HIV screening for all patients aged 13-64 years old who access healthcare for services. To date, 40% of people in the United States have never had an HIV test, and less than 30 % of people in the United States most at risk for acquiring HIV were tested in the past year. Description of Services: Baptist Hospital of Southeast Texas (BHSET) through support from Texas Department of State Health Services (TXDSHS) implemented Routine HIV screening in their ED in October 2011, and with additional support from Gilead Sciences, Inc. FOCUS program in 2016. Patients18 and older, are tested for HIV/HCV and linked to medical care within BHSET, and external community partners. Opt-out routine screening tests those who may not perceive themselves to be at risk and identifies those previously diagnosed for re-engagement in care. CDC reported 15% of those who do not know their status account for 38% of new transmissions, and 23% of those who knew their status, but were not engaged in care accounted for 43% of new transmissions.

Results: BHSET performed 160,000 tests, identified (0.3 % seropositivity) (0.1%) of new diagnosis (.05%) of acute cases, and (95%) linked to care. October 2016 HCV testing has performed 52% testing on patients outside the birth cohort, with a positivity rate of tested 43%.During COVID-19, HIV tests numbered 11,960 (0.1% seropositivity) with (.02%) new diagnosis, (98%) linked to care. HCV tests 9, 487, identified (6% HCV Ab seropositivity), (38% RNA positivity) linked (40%) to care.

Conclusion: BHSET has utilized its policy-driven opt-out HIV routine screening practices, protocols, and processes to improve Jefferson County's HIV prevalence from being ranked 4th in the state with cases of people who are living in 2010 to 14th in 2018.