Identification of Acute HIV Infection Using Fourth-Generation Testing in an Opt-Out Emergency Department Screening Program

Acute HIV Infection and Implications of Fourth-Generation HIV Screening in Emergency Departments

“…Additionally, patients were not tested for HIV infection if blood was not drawn (32% of those who consented for HIV testing) or, in a very limited number of cases, an order was not entered into their electronic medical record. The results from this implementation study parallel findings from other studies reporting nontargeted opt-out HIV screening in EDs (Table 1), 20–37 including the need to perform a large number of HIV tests to identify a relatively small number of infected individuals (ie, about 350 tests per positive result), a prevalence ranging from 0.2% to 0.6%, and the majority of patients not completing testing because they opted out or were ineligible for testing due to the clinical circumstance (eg, severe illness or injury), or because of another practical issue (eg, lack of a blood draw). These limitations raise questions about the overall system-level effectiveness of performing nontargeted HIV screening in an ED, particularly when external resources for integrating this preventive service into practice become increasingly limited.…”

“…In this volume of Annals , Geren et al 20 contribute substantially to our understanding of HIV screening in EDs by reporting programmatic results of nontargeted opt-out screening in a high-volume, urban ED. This study is unique in that it reports, for the first time in an ED setting, the use of fourth-generation HIV testing.…”

Evaluation of hidden HIV infections in an urban ED with a rapid HIV screening program

“…These findings provide conceptual framework and model for exploring the effectiveness of ED-based HIV screening programs. Opt-out, clinical staff-driven, registration/triage-based integrated routine HIV testing models which helps to de-stigmatize HIV by offering testing to every eligible patient are being evaluated currently [16, 17] and have already been shown to increase HIV test offer and test acceptance, to be expected helping curtail the ‘missed opportunities’ we observed in this study.…”

HIV, trauma and the emergency departments: The CDC opt-out approach should be adopted in South Africa

“…[31] This is also likely to be positively influenced by the modern 'fourth-generation' rapid test kits currently available for use in the ED, where almost 25% of newly diagnosed cases would have been missed with older test kits. [32] …”