Understanding <scp>HIV</scp> Screening in the Emergency Department: Is Perception Reality?

Haukoos, Jason S.; Hopkins, Emily

doi:10.1111/acem.12082

Cited by 12 publications

(15 citation statements)

References 25 publications

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“…Future endeavors should consider an implementation science approach to developing innovative HIV testing programs within this setting. [ 2 , 47 , 48 ]…”

Section: Discussionmentioning

confidence: 99%

HIV testing in a South African Emergency Department: A missed opportunity

et al. 2018

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BackgroundSouth Africa has the largest HIV epidemic in the world, with 19% of the global number of people living with HIV, 15% of new infections and 11% of AIDS-related deaths. Even though HIV testing is mandated in all hospital-based facilities in South Africa (SA), it is rarely implemented in the Emergency Department (ED). The ED provides episodic care to large volumes of undifferentiated who present with unplanned injury or illness. Thus, the ED may provide an opportunity to capture patients with undiagnosed HIV infection missed by clinic-based screening programs.Methods and findingsIn this prospective exploratory study, we implemented the National South African HIV testing guidelines (counselor initiated non-targeted universal screening with rapid point of care testing) for 24-hours a day at Frere Hospital in the Eastern Cape from September 1st to November 30th, 2016. The purpose of our study was to quantify the burden of undiagnosed HIV infection in a South African ED setting. Furthermore, we sought to evaluate the effectiveness of the nationally recommended HIV testing strategy in the ED. All patients who presented for care in the ED during the study period, and who were clinically stable and fully conscious, were eligible to be approached by HIV counseling and testing (HCT) staff to receive a rapid point-of-care HIV test. A total of 2355 of the 9583 (24.6%) patients who presented to the ED for care during the study period were approached by the HCT staff, of whom 1714 (72.8%) accepted HIV testing. There was a high uptake of HIV testing (78.6%) among a predominantly male (58%) patient group who mostly presented with traumatic injuries (70.8%). Four hundred (21.6%) patients were HIV positive, including 115 (6.2%) with newly diagnosed HIV infection. The overall prevalence of HIV infection was twice as high in females (29.8%) compared to males (15.4%). Both sexes had a similar prevalence of newly diagnosed HIV infection (6.0% for all females and 6.4% for all males) in the ED.ConclusionsOverall there was high HIV testing acceptance by ED patients. A non-targeted testing approached revealed a high HIV prevalence with a significant burden of undiagnosed HIV infection in the ED. Unfortunately, a counselor-driven HIV testing approach fell short of meeting the testing needs in this setting, with over 75% of ED patients not approached by HCT staff.

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“…Future endeavors should consider an implementation science approach to developing innovative HIV testing programs within this setting. [ 2 , 47 , 48 ]…”

Section: Discussionmentioning

confidence: 99%

HIV testing in a South African Emergency Department: A missed opportunity

et al. 2018

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“…In the past decade, there has been a large investment including dedicated public health resources, and focused ED investigation directed towards optimizing ED-based HIV testing, referral, and linkage to care processes. Some in the ED community considered this investment as a laudable goal 35,36 since many ED patients may not get tested elsewhere, and early identification of infected patients is beneficial for future patient management and treatment. 37 However, as highlighted in the original HIV Care Continuum schema, 4 testing and linkage to care are only two stages of the HIV care cascade.…”

Section: Discussionmentioning

confidence: 99%

HIV Care Continuum for HIV-Infected Emergency Department Patients in an Inner-City Academic Emergency Department

Hsieh

Kelen

Laeyendecker

et al. 2015

Annals of Emergency Medicine

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Background The recently released “HIV Care Continuum” is a cornerstone of the National AIDS Strategy and a model for improving care for those living with HIV. There are no studies exploring the entirety of the HIV Care Continuum for patients in the emergency department (ED). Objective To determine gaps in the HIV Care Continuum in order to identify potential opportunities for improved care for HIV-infected ED patients. Methods A mixed methods approach was employed in one inner-city ED in 2007. Data elements were derived from (1) An identity-unlinked HIV seroprevalence study; (2) An ongoing non-targeted HIV screening program; and (3) A structured survey of known HIV-positive ED patients. Results Identity-unlinked testing of 3,405 unique ED patients found 265 (7.8%) were HIV positive. Of those testing HIV positive, 73% were previously diagnosed [based on self-report, chart review and/or presence of antiretroviral (ARVs) in serum], but only 61% were recognized by the clinician as HIV infected (based on self-report or chart review). Of those positive, 43% were linked to care, 39% were retained in care, 27% were on ARVs, 26% were aware of their receiving ARV treatment, 22% were virally suppressed, and only 9% were self-aware of their viral suppression. Conclusion This study is the first to quantify gaps in HIV care for an ED patient population using the HIV Care Continuum as a framework. Our findings identified distinct phases (i.e. testing, “provider awareness of HIV diagnosis”, and linkage to care) where the greatest opportunities for intervention exist, if appropriate resources were allocated. This schema could serve as a model for other indolent treatable diseases frequently seen in EDs, where continuity of care is critical.

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“…It is noteworthy to add that some emergency physicians have been hesitant in the past to perform HIV testing in the ED for various reasons including difficulty following up on results, inability to counsel patient on results, and lack of access to follow-up. [19][20][21][22] The authors disagree with this notion and, as is demonstrated in this case, it is the duty of the emergency physician to order testing so that an appropriate diagnosis and treatment referral can be given to the patient.…”

Section: An Atypical Presentation Of Pharyngitismentioning

confidence: 96%

“…In 2006 the CDC updated the HIV testing guidelines to include testing all patients who present to healthcare facilities with concern for possible infection, including the ED. [19][20][21][22] It is recommended that counseling should be provided to the patient prior to HIV testing, and also after testing, if the results are in fact positive. [19][20][21][22] A cross-sectional analysis using data from two large national healthcare surveys from the years 2009-2014 was performed and found that HIV testing in EDs was nationally low, despite the updated CDC recommendation in 2006.…”

Section: An Atypical Presentation Of Pharyngitismentioning

confidence: 99%

A 45-year-old Female with an Atypical Presentation of Pharyngitis

Schander

Glickman²,

Weber

et al. 2020

Clinical Practice and Cases in Emergency Medicine

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Introduction: Emergency physicians are trained to treat a variety of ailments in the emergency department (ED), some of which are emergent, while others are not. A common complaint seen in the ED is a sore throat. While most sore throats are easily diagnosed and treated, less common causes are often not considered in the differential diagnoses. Therefore, the purpose of this case study was to present an atypical case of sore throat and discuss differential diagnoses. Case Presentation: The patient was a 45-year-old female who presented to the ED with a three-day history of sore throat that was exacerbated by eating and drinking. The patient was not on any prescription medications, but tried over-the-counter medications for the sore throat without any improvement in symptoms. Review of systems was positive for sore throat, fevers, and chills. Physical examination of her oropharynx revealed mildly dry mucous membranes with confluent plaques and white patchy ulcerative appearance involving the tongue, tonsils, hard palate, and soft palate. Rapid streptococcal antigen, mononucleosis spot test, and KOH test were performed and found to be negative. Discussion: After initial testing was negative, a follow-up complete blood count with differential and complete metabolic profile were ordered. The patient was found to have decreased lymphocytes and platelets. Based upon those results, a diagnosis was made in the ED, the patient was started on medication, and further laboratory workup was ordered to confirm the diagnosis. ED providers should consider non-infectious as well as infectious causes for a sore throat, as this might lead to a diagnosis of an underlying condition.

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Understanding HIV Screening in the Emergency Department: Is Perception Reality?

Cited by 12 publications

References 25 publications

HIV testing in a South African Emergency Department: A missed opportunity

HIV testing in a South African Emergency Department: A missed opportunity

HIV Care Continuum for HIV-Infected Emergency Department Patients in an Inner-City Academic Emergency Department

A 45-year-old Female with an Atypical Presentation of Pharyngitis

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