2009 US Emergency Department HIV Testing Practices

Rothman, Richard E.; Hsieh, Yu Hsiang; Harvey, Leah; Connell, Samantha; Lindsell, Christopher J.; Haukoos, Jason S.; White, Douglas A.E.; Kecojevic, Aleksandar; Lyons, Michael S.

doi:10.1016/j.annemergmed.2011.03.016

Cited by 41 publications

(38 citation statements)

References 6 publications

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“…Our results suggest that these sites need ongoing educational efforts regarding AHI with better access to diagnostic tools and support recent measures to facilitate HIV-1 testing in such settings. 24 A widely accepted belief is that patients presenting with AHI invariably have very high viral loads. In this cohort, 10 patients with confirmed AHI (including 8 with negative EIA tests at diagnosis) never had HIV-1 levels exceeding 10,000 copies/ml.…”

Section: Discussionmentioning

confidence: 99%

Acute HIV-1 Infection in the Southeastern United States: A Cohort Study

McKellar

Cope²,

McGee

et al. 2013

AIDS Research and Human Retroviruses

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In 1998 a collaboration between Duke University and the University of North Carolina, Chapel Hill (UNC) was founded to enhance identification of persons with acute HIV-1 infection (AHI). The Duke-UNC AHI Research Consortium Cohort consists of patients ‡ 18 years old with a positive nucleic acid amplification test (NAAT) and either a negative enzyme immunoassay (EIA) test or a positive EIA with a negative/indeterminate Western blot. Patients were referred to the cohort from acute care settings and state-funded HIV testing sites that use NAAT testing on pooled HIV-1 antibody-negative samples. Between 1998 and 2010, 155 patients with AHI were enrolled: 81 (52%) African-Americans, 63 (41%) white, non-Hispanics, 137 (88%) males, 108 (70%) men who have sex with men (MSM), and 18 (12%) females. The median age was 27 years . Most (n = 138/155) reported symptoms with a median duration of 17.5 days. The median nadir CD4 count was 408 cells/mm 3 (IQR 289-563); the median observed peak HIV-1 level was 726,859 copies/ml (IQR 167,565,728). The emergency department was the most frequent site of initial presentation (n = 55/152; 3 missing data). AHI diagnosis was made at time of first contact in 62/137 (45%; 18 missing data) patients. This prospectively enrolled cohort is the largest group of patients with AHI reported from the Southeastern United States. The demographics reflect the epidemic of this geographic area with a high proportion of African-Americans, including young black MSM. Highlighting the challenges of diagnosing AHI, less than half of the patients were diagnosed at the first healthcare visit. Women made up a small proportion despite increasing numbers in our clinics.

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Section: Discussionmentioning

confidence: 99%

Acute HIV-1 Infection in the Southeastern United States: A Cohort Study

McKellar

Cope²,

McGee

et al. 2013

AIDS Research and Human Retroviruses

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“…The positive HIV test rate in urban EDs is higher than the local seroprevalence, which implies the cost effectiveness of screening in EDs (Table 3) (9,11,12,16,19,25,26,28,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). Therefore, the US CDC recommends ED HIV screening and suggests that this strategy is particularly effective in health care facilities with HIV prevalence rates above 0.1z.…”

Section: Discussionmentioning

confidence: 99%

“…HIV screening in EDs can identify patients belonging to high-risk groups and advanced HIV stages with lower CD4 lymphocyte counts (9)(10)(11)16,(19)(20)(21)(22)(23)(24). The positive HIV test rate in urban EDs is higher than the local seroprevalence, which implies the cost effectiveness of screening in EDs (Table 3) (9,11,12,16,19,25,26,28,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41).…”

Section: Discussionmentioning

confidence: 99%

“…Other factors involved in HIV testing in the ED: A stratified analysis was performed to test the effects of previous HIV testing among patients who underwent the HIV test in the ED (Table 2) (9,11,12,16,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Of patients who underwent an HIV test at our ED, men who had sex with men (OR: 2.43, 95z CI: 1.01-5.87, P ＝ 0.0419), patients who had sex with a different gender (OR: 1.74, 95z CI: 1.34-2.25, P ＜ 0.0001), patients who had sex partners (OR: 1.77, 95z CI: 1.37-2.29, P ＜ 0.0001), and patients who had multiple sex partners (OR: 7.11, 95z CI: 2.72-18.59, P ＜ 0.0001) were associated with having previously been tested.…”

Section: Demographic Information Of Patients Visiting the Edmentioning

confidence: 99%

“…In the US, the majority of VCT in EDs is performed at academic hospitals and trauma centers (15)(16)(17). An estimated 5,000 to 10,000 patients visit the EDs of the main teaching hospitals in Taiwan each month.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Rapid Human Immunodeficiency Virus Screening in an Emergency Department in a Region with Low HIV Seroprevalence

Shih

Hsu

et al. 2015

Jpn J Infect Dis

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Correlates of HIV Testing Refusal Among Emergency Department Patients in the Opt-Out Testing Era

Setse

Maxwell

2013

AIDS Behav

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Opt-out HIV screening is recommended by the CDC for patients in all healthcare settings. We examined correlates of HIV testing refusal among urban emergency department (ED) patients. Confidential free HIV screening was offered to 32,633 ED patients in an urban tertiary care facility in Washington, DC, during May 2007-December 2011. Demographic differences in testing refusals were examined using χ(2) tests and generalized linear models. HIV testing refusal rates were 47.7 % 95 % CI (46.7-48.7), 11.7 % (11.0-12.4), 10.7 % (10.0-11.4), 16.9 % (15.9-17.9) and 26.9 % (25.6-28.2) in 2007, 2008, 2009, 2010 and 2011 respectively. Persons 33-54 years of age [adjusted prevalence ratio (APR) 1.42, (1.36-1.48)] and those ≥ 55 years [APR 1.39 (1.31-1.47)], versus 33-54 years; and females versus males [APR 1.07 (1.02-1.11)] were more likely to refuse testing. Opt-out HIV testing is feasible and sustainable in urban ED settings. Efforts are needed to encourage testing among older patients and women.

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2009 US Emergency Department HIV Testing Practices

Cited by 41 publications

References 6 publications

Acute HIV-1 Infection in the Southeastern United States: A Cohort Study

Acute HIV-1 Infection in the Southeastern United States: A Cohort Study

Rapid Human Immunodeficiency Virus Screening in an Emergency Department in a Region with Low HIV Seroprevalence

Correlates of HIV Testing Refusal Among Emergency Department Patients in the Opt-Out Testing Era

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