A Comparison of Parallel and Integrated Models for Implementation of Routine HIV Screening in a Large, Urban Emergency Department

Abstract

Non-targeted, integrated HIV screening, with test offer and order by ED nurses during patient triage, is feasible and resulted in an increased frequency of HIV screening and a threefold increase in the absolute number of newly identified HIV-positive patients.

Expanding Hospital Human Immunodeficiency Virus Testing in the Bronx, New York and Washington, District of Columbia: Results From the HPTN 065 Study

“…Hospitals were encouraged to use routine laboratory-based HIV tests for screening because they facilitate testing larger numbers of patients and were better at identifying acute infections that would be missed by point-of-care antibody tests. [10, 11, 28–30] At the two hospitals in the Bronx and the two in DC that successfully adopted centralized laboratory HIV testing during the study, the annual number of tests conducted during ED visits more than doubled. However, in most participating hospitals, point-of-care rapid HIV tests constituted the majority of tests performed during the study period.…”

Unique Needs for the Implementation of Emergency Department Human Immunodeficiency Virus Screening in Adolescents

“…In line with the existing universal opt‐out HIV screening program in place in the ED of an affiliated adult hospital, 31 serum‐based fourth‐generation HIV testing was utilized for screening and run in the central laboratory (Architect HIV Ag/Ab combo test, Abbott Laboratories, Abbott Park, IL). The test was ordered through the electronic health record, and the charge for this test was incorporated into the ED bill as with all tests obtained during the visit.…”

“…29 Young adults (20-29 years) comprise 39% of new infections, and late-stage disease is common at diagnosis. 28,29,30 We have previously described a high burden of newly diagnosed late-stage HIV in adolescents in our pediatric health care system and have determined that asymptomatic HIV-infected adolescents may be missed during pediatric ED visits. 3,4 We aimed to 1) implement a pilot of routine adolescent HIV screening in the pediatric ED and 2) determine the unique barriers to routine pediatric ED adolescent HIV screening in a region of high HIV prevalence.…”

Potential Contributions of Clinical and Community Testing in Identifying Persons with Undiagnosed HIV Infection in the United States

“…27 confirmed by our review of identified articles. 2 , 28 - 32 We also assume that disclosure of risk (that is, letting the health care provider know that one belongs to a high-risk group) is a necessary and sufficient condition for annual testing. We derive the portion of high-risk individuals who disclose their risk from a Canadian study for MSM 33 and data from MSM in Chicago using findings from the 2014 NHBS 34 and additional calculations (available from authors).…”