Clinician judgment as a tool for targeting HIV counseling and testing in North Carolina state mental hospitals, 1994

HIV infection increasingly affects populations that may not appear at high risk based on the use of some traditional targeting strategies. To shed som e light on how to more sensitively/effectively identify people who need rou tine HIV testing and counseling, the objective of this study is to determin e the prevalence of HIV infection in North Carolina state mental hospitals and to evaluate clinician judgment as a tool for targeting HIV counseling a nd testing. The design used is a blinded seroprevalence study. The study po pulation includes all patients admitted to North Carolina state mental hosp itals between March Ist and May 31st, 1994. The main outcome measures are t he HIV seroprevalence, demographic and diagnostic features, and clinician a ssessment of the likelihood of HIV infection. The results of the study find that of 2159 study subjects, 35 persons (1.6%) were infected with HIV; of these, 14 (40%) were not previously known to be infected. All 35 HIV infect ions occurred in persons aged 13-59 years. Within this age group, infection rates were significantly higher for Blacks, males, persons who had a diagn osis of organic brain disease, and persons who had multiple psychiatric dia gnoses. However, testing strategies that targeted any of the higher risk gr oups were insensitive. The rate of HIV infection for persons judged by the admitting clinician to have a high or intermediate likelihood of HIV infect ion was 26.4 times higher than the rate for those judged to have a low like lihood of infection (2.1 vs. 0.1%, 95% confidence intervals: 3.5-201.3). Of the 14 previously undiagnosed HIV-infected persons, 13 were judged by clin icians to have a high or intermediate likelihood of HIV infection. Moreover , 1258 persons were correctly assessed to have a low likelihood of infectio n. Conclusions from this study are that an HIV counseling and testing strat egy targeting persons (in this setting aged 13-59 years) who were judged by clinicians to have a high or intermediate likelihood of infection, would h ave identified more than 90% of previously undetected infections while subs tantially reducing the number of negative HIV tests performed.