Targeted HIV screening in the emergency department

Spagnolello, Ornella; Reed, Matthew J

doi:10.1007/s11739-021-02648-5

Cited by 4 publications

(3 citation statements)

References 68 publications

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“…Nevertheless, its long-term implementation requires additional funding and increased staff resources, limiting its application in resource-poor settings. Although most testing is done in areas with a high prevalence of HIV, targeted screening may also be appropriate in areas with a low HIV prevalence [24]. As mentioned previously, the present strategy was cost-efficient for the six targeted situations.…”

Section: Discussionmentioning

confidence: 83%

Feasibility of a selective targeted strategy of HIV testing in emergency departments: a before-after study

González del Castillo,

Mirò,

Miguens

et al. 2023

European Journal of Emergency Medicine

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Background and importance The rates of hidden infection and late diagnosis of HIV still remain high in Western countries. Missed diagnostic opportunities represent the key point in changing the course of the epidemic. Objective To evaluate the feasibility and results of implementation of a selective strategy to test for HIV in the emergency department (ED) in patients with six pre-defined medical situations: sexually transmitted infections, herpes zoster, community-acquired pneumonia, mononucleosis syndrome, practice of chemsex (CS) or request of post-exposure prophylaxis. Design This quasi-experimental longitudinal study evaluated the pre- and post-implementation results of HIV testing in the six aforementioned clinical scenarios. Settings and participants Patients attended 34 Spanish EDs. Intervention or exposure The intervention was an intensive educational program and pathways to facilitate and track orders and results were designed. We collected and compared pre- and post-implementation ED census and diagnoses, and HIV tests requested and results. Outcome measures and analysis The main outcome was adherence to the recommendations. Secondary outcomes were to evaluate the effectiveness of the program by the rate of positive test and the new HIV diagnoses. Differences between first and second periods were assessed. The magnitude of changes (absolute and relative) was expressed with the 95% confidence interval (CI). Main results HIV tests increasing from 7080 (0.42% of ED visits) to 13 436 (relative increase of 75%, 95% CI from 70 to 80%). The six conditions were diagnosed in 15 879 and 16 618 patients, and HIV testing was ordered in 3393 (21%) and 7002 (42%) patients (increase: 97%; 95% CI: 90–104%). HIV testing significantly increased for all conditions except for CS. The positive HIV test rates increased from 0.92 to 1.67%. Detection of persons with undiagnosed HIV increased from 65 to 224, which implied a 220% (95% CI: 143–322%) increase of HIV diagnosis among all ED comers and a 71% (95% CI: 30–125%) increase of positive HIV tests. Conclusion Implementation of a strategy to test for HIV in selective clinical situations in the ED is feasible and may lead to a substantial increase in HIV testing and diagnoses.

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Section: Discussionmentioning

confidence: 83%

Feasibility of a selective targeted strategy of HIV testing in emergency departments: a before-after study

González del Castillo,

Mirò,

Miguens

et al. 2023

European Journal of Emergency Medicine

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“…The ED triage setting is increasingly being used to address many safety issues, such as falls risk, intimate partner violence, suicide risk screening, and infectious disease screening, and the utility of universally addressing tobacco use in the ED remains to be seen [80][81][82][83]. Many public policies have been instituted to address smoking cessation and it remains to be seen if any policies should or will be implemented in the ED [84].…”

Section: Knowledge Gaps and Research Opportunitiesmentioning

confidence: 99%

A selective review of smoking cessation interventions in the emergency department

et al. 2022

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Background Emergency department (ED) patients disproportionally smoke compared to the general population and frequently utilize the ED for routine, urgent, and emergent care. Thus, the ED is a target-rich environment for interventions aimed at increasing smoking cessation, especially among vulnerable populations. Promotion of smoking cessation in the ED has the potential to address health inequalities and reach patients that experience significant barriers to accessing preventive care and lifestyle modifications. Topics of review This narrative review presents a concise summary of the major smoking cessation strategies studied in the ED setting for adults, children, and pregnant ED patients. Additionally, this review presents the strategies to increase the uptake of smoking cessation in the ED, as well as an international perspective of smoking cessation efforts in the ED. Past and ongoing efforts to improve smoking cessation among ED patients are discussed, and critical knowledge gaps and research opportunities are highlighted. Conclusion Smoking cessation is both efficacious and feasible during an ED visit, with multiple options available to both adults, children, parents, and pregnant patients. Little standardization among cessation strategies among EDs has been demonstrated, despite the ED being uniquely positioned to address disparities in smoking cessation and contribute towards national smoking cessation goals. During most ED visits, any health care team member can address ongoing tobacco use, and smoking cessation can easily be related to the context of the patient’s presenting complaint. To be effective, health care systems and teams must recognize the ED as a suitable location to engage with patients regarding their knowledge and awareness of ongoing smoking use, and are well suited to provide and initiate effective smoking cessation treatments.

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“…There is strong evidence that an early diagnosis of an HIV infection and subsequent treatment can result in a markedly improved prognosis for the individual ( 4 , 5 ). Moreover, the cost of treatment and care for individuals diagnosed early is significantly lower than for those diagnosed at a late stage of infection.…”

Section: Introductionmentioning

confidence: 99%

Understanding Individual Barriers to HIV Testing Among Undergraduate University Students: Results From a Cross-Sectional Study in Italy

et al. 2022

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BackgroundIn Europe during 2019, just over half of those with HIV were diagnosed at a late stage of infection. Even though HIV testing is crucial for all strategies related to care, prevention and treatment of HIV/AIDS, we hypothesized that it is less practiced among university students, and, therefore, this study aimed to assess the uptake and factors associated with HIV testing in southern part of Italy.MethodsA cross-sectional study was conducted from 1st to 31st July 2020 among undergraduate university students aged 18–29 years. Data were collected through an anonymous online questionnaire and included questions on socio-demographic and sexual history characteristics, knowledge and attitudes toward HIV infection, sexual and testing behaviors, and sources of information about HIV.FindingsAmong 1007 students, 41.5 and 54.7% knew that in Italy the test for early detection of HIV infection has not to be prescribed by a physician and that it is provided to anyone free of charge, respectively. Only 16.2% of the eligible students reported having ever tested for HIV and a very similar proportion (17.8%) was displayed among those who reported risky sexual behaviors. The multiple logistic regression analysis results indicated that the strongest predictor of HIV testing was attending medical or life sciences majors.InterpretationThe uptake of HIV testing was low among Italian university students. Effective strategies to increase HIV testing and diagnoses have to aim at overarching individual barriers, such as lack of knowledge about information around the test itself.FundingThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Targeted HIV screening in the emergency department

Cited by 4 publications

References 68 publications

Feasibility of a selective targeted strategy of HIV testing in emergency departments: a before-after study

Feasibility of a selective targeted strategy of HIV testing in emergency departments: a before-after study

A selective review of smoking cessation interventions in the emergency department

Understanding Individual Barriers to HIV Testing Among Undergraduate University Students: Results From a Cross-Sectional Study in Italy

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