How to best conduct universal HIV screening in emergency departments is far from settled

Escudero, Daniel J.; Bahamón, Mónica; Panakos, Patricia; Hercz, Daniel; Seage, George R.; Merchant, Roland C.

doi:10.1002/emp2.12352

Cited by 8 publications

(5 citation statements)

References 21 publications

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“…Across the United States, EDs serve as a safety net for medically underserved patients without access to alternative forms of health care. 3 Furthermore, EDs serve populations disproportionately affected by HIV, 4 regularly treat patients presenting with viral syndrome symptoms, 5 and routinely collect blood as a part of patient care. 6 Despite previous work by our group demonstrating that 24% of patients presenting to a subset of US EDs reported having never been tested for HIV (23% of whom reported engaging in recent ongoing HIV risk-taking behaviors), 7 only a minority of EDs offer routine HIV testing.…”

Section: Introductionmentioning

confidence: 99%

HIV Testing at Visits to US Emergency Departments, 2018

Clay¹,

Ling²,

Bennett³

2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: An early HIV diagnosis improves patient outcomes, reduces the burden of undiagnosed HIV, and limits transmission. There is a need for an updated assessment of HIV testing rates in the emergency department (ED). Setting:The National Hospital Ambulatory Medical Care Survey sampling ED visits were weighted to give an estimate of ED visits across all US states in 2018. Methods:We analyzed patients aged 13-64 years without known HIV and estimated ED visits with HIV testing and then stratified by race, ethnicity, and region. Descriptive statistics and mapping were used to illustrate and compare patient, visit, and hospital characteristics for visits with HIV testing.Results: Of 83.0 million weighted visits to EDs in 2018 by patients aged 13-64 years without a known HIV infection (based on 13,237 National Hospital Ambulatory Medical Care Survey sample visits), HIV testing was performed in 1.05% of visits. HIV testing was more frequent for patients aged 13-34 years compared with that for patients aged 35-64 years (1.32% vs. 0.82%, P = 0.056), Black patients compared with that for White and other patients (1.73% vs. 0.79% and 0.41%, P = 0.002), Hispanic or Latino patients compared with that for non-Hispanic or Latino patients (2.18% vs. 0.84%, P = 0.001), and patients insured by Medicaid compared with that for patients insured by private or other insurance (1.71% vs. 0.64% and 0.96%, P = 0.003). HIV testing rates were the highest in the Northeast (1.72%), followed by the South (1.05%). Conclusions: HIV testing occurred in a minority of ED visits.There are differences in rates of HIV testing by race, ethnicity, and location. Although rates of testing have increased, rates of ED-based HIV testing remain low.

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Section: Introductionmentioning

confidence: 99%

HIV Testing at Visits to US Emergency Departments, 2018

Clay¹,

Ling²,

Bennett³

2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Although this study was conducted at a single site, the results are likely generalizable to other urban trauma centers serving populations with relatively high prevalence of HIV. While routine, opt-out HIV screening is now common in EDs throughout the US, implementation and participation vary, [ 2 ] and high acuity patients such as those presenting with major trauma, may be more likely to be excluded from screening. At the same time, this study shows that trauma patients may have higher rates of HIV than other ED patients.…”

Section: Discussionmentioning

confidence: 99%

“…Routine emergency department (ED) HIV screening has been recommended by the Centers for Disease Control and Prevention (CDC) since 2006 1 and has been shown to have a positive impact on screening rates [ 2 ]. Routine screening has been implemented at many EDs around the country, with published screening rates generally around 25–30% of all eligible patients [ 3 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

High Rate of HIV Among Trauma Patients Participating in Routine Emergency Department Screening

et al. 2023

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Limited published data suggest rates of HIV may be high among trauma patients. This study compares rates of HIV screening and diagnosis among trauma and medical patients at a Level 1 trauma center emergency department (ED) with a universal HIV screening program. This is a retrospective cross-sectional study of all ED encounters from May 1, 2018, through May 1, 2021. Duplicate encounters, encounters with repeat testing within one year, and patients younger than 18 or older than 65 were excluded. Chi-squared analysis was used to compare demographics, rates of HIV testing, new and known HIV infections, and linkage to care between trauma and medical patients. After exclusion criteria were applied, 147,430 encounters from 91,468 unique patients were analyzed. Trauma comprised 7,497 (5.4%) encounters. Trauma patients were less likely to be screened for HIV than medical patients (18.1% vs 25.6%; OR 0.64; 95%CI, 0.61–0.68, p < .01). Trauma patients had higher rates of HIV (2.2% vs 1.3%; OR 1.78; 95% CI, 1.22–2.58, p < .01). Both trauma and medical patients would benefit from strategies to increase screening. Including trauma patients in routine ED HIV screening should be a priority to increase diagnosis rate and linkage to care in key populations.

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“…Electronic health record‐based opportunistic HIV screenings in EDs allow for the identification of new HIV cases among people who may underestimate their exposure risk or lack access to traditional HIV testing services [ 19 , 20 , 21 ]. They are also useful for detecting and controlling possible local disease outbreaks [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments

Pinto¹,

Gorgulho²,

Esteves³

et al. 2022

HIV Medicine

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Introduction: Late HIV diagnosis is associated with increased morbidity, mortality and risk of onward transmission. Increasing HIV early diagnosis is still a priority. In this observational study with historical control, we determined the impact of an opportunistic HIV screening strategy in the reduction of late diagnosis and missed opportunities for earlier diagnosis. Methods: The screening programme was implemented in the emergency department (ED) of the Hospital de Cascais between September 2018 and September 2021. Eligible patients were aged 18-64 years, with no known HIV diagnosis or antibody testing performed in the previous year, and who required blood work for any reason. Out of the 252 153 emergency visits to the ED, we identified 43 153 (17.1%) patients eligible for HIV testing. Among the total population eligible for the screening, 38 357 (88.9%) patients were ultimately tested for HIV. Impact of the ED screening was determined by analysing late diagnosis in the ED and missed opportunities at different healthcare settings 3 years before and 3 years after the start of the ED screening. Results: After 3 years of automated HIV ED testing, we found 69 newly diagnosed HIV cases (54% male, 39% Portuguese nationals, mean age 40.5 years). When comparing the characteristics of HIV diagnoses made in the ED, we observed a significant reduction in the number of people with late HIV diagnosis before and after implementation of the screening programme (78.4% vs. 39.1%, respectively; p = 0.0291). The mean number of missed opportunities for diagnosis also fell (2.6 vs. 1.5 annual encounters with the healthcare system per patient, p = 0.0997). Conclusions: People living with HIV in Cascais and their providers miss several opportunities for earlier diagnosis. Opportunistic screening strategies in settings previously deemed to be unconventional, such as EDs, are feasible and effective in mitigating missed opportunities for timely HIV diagnosis.Inês Vaz-Pinto and Ana Gorgulho contributed equally to this work.

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How to best conduct universal HIV screening in emergency departments is far from settled

Cited by 8 publications

References 21 publications

HIV Testing at Visits to US Emergency Departments, 2018

HIV Testing at Visits to US Emergency Departments, 2018

High Rate of HIV Among Trauma Patients Participating in Routine Emergency Department Screening

Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments

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