In October 2011, staff at four Vancouver hospitals began offering HIV tests to patients upon admission when other blood work was being ordered.
Dr. Rka Gustafson, medical health officer and medical director of communicable disease control for Vancouver Coastal Health, said nearly 60 patients have been diagnosed with HIV at the four hospitals - Vancouver General Hospital, St. Paul's Hospital, UBC Hospital and Mount Saint Joseph Hospital -since the program began.
During that time, more than 8,000 admitted patients have been tested -approximately four times as many as in previous years, Gustafson said. In addition, more than 4,000 emergency room patients have been tested for HIV - more than 12 times as many as in previous years.
Approximately 94 per cent of patients offered the test as part of routine hospital care agreed to have it done, she said.
"What was key was the acceptance rate," Gustafson said. "The barrier is not the patients. That has been proven in other jurisdictions like the United Kingdom and United States... but we had to prove it here."
Prior to the pilot project, only those patients who were known to have a high risk for HIV, such as those who use intravenous drugs, were offered the test. In many cases patients who didn't have, or admit to, high risk factors were overlooked, she said.
"Because we [health care professionals] had to actively think of it in the past, we missed a lot of patients," Gustafson said.
Implementing the program required a change of mindset for doctors and nurses, but also required solving logistics challenges for laboratory staff, she said.
"Saying, 'we offer all patients HIV testing,' is a small number of words, but its a big practice change," Gustafson said. "The important thing is one education session isn't going to do it. You have to go back and say, '[we] really mean routinely, [we] really mean all patients.'"
Gustafson said the smaller hospitals, like Mount Saint Joseph, found it easier to implement because of the smaller number of staff, however in all cases it did require, "a fair amount of work and a fair amount of local problem solving."
Ultimately getting buy-in by hospital staff requires showing them the potential health benefits for patients, she said.
In addition to significantly reducing the risk of transmission, an early diagnosis can add years to the life of an HIV-positive patient.
For a 20-year-old patient, an early diagnosis means the difference between an average life expectancy of 58 years and 73 years, Gustafson said.
