Modest Public Health Impact of Nontargeted Human Immunodeficiency Virus Screening in 29 Emergency Departments

Abstract

Nontargeted HIV testing in EDs was feasible but identified only a few new HIV diagnoses, often at late stages, and, unexpectedly, most patients belonged to a high-risk group. Our findings do not support the implementation of nontargeted screening of the general population in EDs.

Is Self-Perceived HIV Risk Congruent with Reported HIV Risk Among Traditionally Lower HIV Risk and Prevalence Adult Emergency Department Patients? Implications for HIV Testing

“…However, it should be recalled that ED patients typically decline HIV testing out of a belief that they are not at risk for an infection, [53][54][55][56][57][58][59][60][61][62][63][64][65] and many patients who decline testing do have significant risk for having an undiagnosed infection. 21 When an opt-out approach without a risk assessment is used by ED clinicians, patients likely conduct their own risk assessment internally and perhaps subconsciously, and maybe inaccurately.…”

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

“…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).…”

“…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.…”

“…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.…”

“…In the United States (US), HIV tests performed in EDs had higher positivity rates (2-7z) than testing done as part of regular voluntary counseling and testing (VCT) at health care facilities (1.5z) and sexually transmitted infection (STI) clinics for high-risk groups (2z) (5)(6)(7)(8). New HIV cases diagnosed in the ED had higher CD4 cell levels and were earlier stages of HIV infections compared to HIV diagnosed elsewhere (9)(10)(11)(12). The flexibility of the screening wait time and the ED setting were friendlier and more accessible to the general population; therefore, HIV infection was identified in ED in individuals who were not members of the traditional high-risk groups (9,(12)(13)(14).…”