Testing for HIV infection in the emergency departments of 2 hospitals in the Southeastern United States

Abstract

Background In 2006, the Centers for Disease Control and Prevention (CDC) recommended non‐targeted, opt‐out HIV screening in all healthcare settings, including emergency departments (EDs). Multiple HIV testing programs have been implemented in EDs across the United States with varying designs and testing platforms. We report findings from a free, non‐targeted, rapid HIV testing program in 2 EDs in the Southeastern United States. Methods From 2008 to 2012, adults ≥18 years of age were offered free rapid HIV testing using an oral swab test (OraQuick ADVANCE Rapid HIV‐1/2 antibody test) in the EDs of a large academic medical center and an affiliated community hospital in Durham, North Carolina. Results In total, 5443 ED patients were offered HIV testing. The overall acceptance rate was 66.9% (3639/5443). Younger persons were significantly more likely to accept testing (78.2% for 18–29 years old vs 67.1% for ≥30 years old; P < 0.001) as were Black participants (72.6% Black vs 66.5% White; P < 0.001). Acceptance rates improved significantly after opt‐out oral consent replaced written consent (71.3% vs 63.1%; P < 0.001). Seven new HIV diagnoses were confirmed during the testing program, resulting in a seropositivity rate of 0.19% (7/3639). There were 8 false–positive rapid oral HIV tests (positive predictive value = 46.7%). Conclusions Although the number of new HIV diagnoses was low, implementation of this rapid, non‐targeted ED screening program was feasible with high acceptance rates, particularly after introducing the opt‐out oral consent approach.

Racial differences in testing for infectious diseases: An analysis of jail intake data

“…Professional medical organizations and the Federal Bureau of Prisons support opt-out HCV screening for all people who are incarcerated [ 2 , 18 ]. Data from testing in emergency rooms shows increased uptake of opt-out HIV testing by Black people compared to white people [ 48 ].…”

Efficiency of screening for human immunodeficiency virus infection in emergency departments: a systematic review and meta-analysis

“…Se identificaron un total de 273 artículos de los cuales 151 de ellos se excluyeron por ser registros duplicados entre las diferentes combinaciones de términos empleadas. De los 122 artículos restantes se excluyeron 110 por no cumplir con los criterios de inclusión, quedando 12 artículos (14 estudios) [12][13][14][15][16][17][18][19][20][21][22][23] . Dos artículos 20,21 aportan la información de 4 subestudios comparando dos estrategias de despistaje en dos periodos diferentes.…”

“…La Tabla 1 muestra las características de los artículos incluidos. Del total de los 12 artículos publicados, 8 (66,7%) se publicaron antes del 2019, todos se realizaron en hospitales urbanos y solo uno de ellos 23 fue multicéntrico (2 centros). En relación a la región de la Figura 1.…”

Implied consent for HIV testing in the UK: time for a new approach?

“…Most studies evaluating expanded HIV testing have identified new infections at rates above the 1/1,000 threshold of cost-effectiveness, implying cost savings if universally applied. 16 , 17 …”