Routine Universal Screening for HIV

  • Priority Population
    General Population (Ages 16 and Older)
  • Setting
    Emergency Departments and Ryan White HIV/AIDS Program Clinics
  • Location
    Houston, TX
  • Intervention Focus
    Linkage, Re-engagement, and Retention
  • Study Period


The Routine Universal Screening for HIV (RUSH) intervention facilitates linkage to and retention in care through an opt-out HIV testing program for people 16 and older who are in an emergency department or other clinical setting and have an intravenous line inserted and/or have blood drawn.

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Download the Intervention Summary

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Intervention Outcomes

47.1% of clients were actively retained in care six months after implementation.
Clients’ viral suppression rate increased from 22.8% pre-intervention to 34% post-intervention.

Intervention Components

  1. Address Staffing and Workflow Needs
  2. Secure Organizational Buy-In
  3. Establish a Steering Committee
  4. Determine Funding Streams
  5. Recruit Additional Staff
  6. Develop Promotional Materials
  7. Train ED Staff on RUSH Procedures
  8. Implement and Sustain RUSH

Cost Analysis

The RUSH intervention cost analysis is not currently available. However, you can use the CIE Cost Calculator to create an estimate of the cost of implementing the intervention at your organization.

Challenges & Solutions

Challenge: Lack of buy-in
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Identify a champion within your organization who can promote it to leadership. Highlight the benefits of implementing RUSH.

Challenge: Lack of after-hours service linkage worker (SLW) coverage
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Expand after-hours SLW coverage or hire an SLW who is dedicated to following up with clients who are not linked to care after receiving an HIV diagnosis.

Challenge: Staff turnover and ongoing RUSH training
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Develop a strategy for disseminating RUSH training to new staff, including building institutional knowledge by coaching RUSH-focused staff, who can in turn train new staff.

Challenge: Lack of diverse RWHAP funding
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Assess the availability of RWHAP Part A funding during the planning phase so you can strategize ways to offset costs if that funding is not available. Discuss repurposing existing funding; petition leadership for more sustainable funding; partner with agencies that have RWHAP funding or other diverse funding streams.

Challenge: HIV testing laws
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Learn from organizations that have implemented similar interventions to identify approaches that may be effective in your jurisdiction. Also, learn about testing laws in other jurisdictions that promote access to routine opt-out HIV testing.


Success of Supplementing National HIV Testing Recommendations with a Local Initiative in a Large Health Care System in the U.S. South
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Using Nonrapid HIV Technology for Routine, Opt-Out HIV Screening in a High-Volume Urban Emergency Department
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Unintended Adverse Consequences of Electronic Health Record Introduction to a Mature Universal HIV Screening Program
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Benefits of a Routine Opt-Out HIV Testing and Linkage to Care Program for Previously Diagnosed Patients in Publicly Funded Emergency Departments in Houston, TX
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State HIV Testing Laws
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Acute HIV Discovered During Routine HIV Screening with HIV Antigen-Antibody Combination Tests in 9 U.S. Emergency Departments
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Advancing Digital Health
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Tips for Implementing the RUSH (Routine Universal Screening for HIV) Intervention
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Anti-Retroviral Treatment and Access to Services (ARTAS)
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ACTS (Advise, Consent, Test, Support)
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Using Ryan White Funds to Support Routine HIV Testing in a Large Municipal Healthcare System
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Three Years of Routine Screening for HIV in a Large Urban Hospital System: What Has Been Achieved?
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HIV Service Linkage Worker Requirements and Job Description
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NASTAD Trauma-Informed Approaches Toolkit
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