In 2006, the CDC shared revised guidance recommending HIV testing be provided to individuals 13-64 years of age, regardless of risk, in all health-care settings unless patients opt out of the service. This approach, known as Routine Opt-Out HIV Testing (ROOT), is key in identifying persons with undiagnosed HIV, persons previously testing positive but not engaged in HIV care or virally suppressed, and persons testing negative that could be referred to preventative services.

Although ROOT has contributed to increased HIV testing across the United States, wide-scale implementation across San Diego County has been slow. As part of the Ending the HIV Epidemic Initiative (EHE), the County of San Diego partnered with the University of California-San Diego (UCSD) to implement a systems-level strategy to integrate ROOT activities across multiple UCSD departments. ROOT was first implemented at UCSD’s Children’s Emergency Department, Student Health Services, and Urgent Care, with Internal Medicine, Family Medicine, and Obstetrics and Gynecology outpatient settings added in the second half of the year.

In the first year of the program, 11,766 HIV screening tests were completed, yielding four new HIV infections in which patients were linked to care within two weeks. Successful implementation of this project required large-scale operational changes, increased inter-departmental communication, and buy-in from department champions spearheading efforts with front-line staff. Lessons from this implementation can be used to support other agencies in increasing ROOT efforts, leading to increased detection of HIV infections, timely access to care, reduced transmission, and progress made towards meeting local EHE goals.