Using Nonrapid HIV Technology for Routine, Opt-out HIV Screening in a High-Volume Urban Emergency Department

Hoxhaj, S.; Davila, Jessica A.; Modi, Payal; Kachalia, Neal; Malone, Ken; Ruggerio, Michael C.; Miertschin, Nancy; Brock, Patricia; Fisher, Angela; Mitts, Beau; Giordano, Thomas P.

doi:10.1016/j.annemergmed.2011.03.030

Cited by 54 publications

(48 citation statements)

References 15 publications

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“…To overcome these barriers, some highvolume emergency departments have used opt-out screening and conventional (nonrapid) testing technology to screen all patients who have blood collected by batching the blood hourly. 48 Linkage-to-care concerns are enhanced in the scenario in which a patient is diagnosed as having HIV after being screened in a health care setting but does not seek HIV care. 49 In one study, only 48% of patients sought HIV care within 3 months of their HIV diagnosis, with 22% not seeking HIV care at 12 months.…”

Section: Systemic Barriersmentioning

confidence: 99%

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

Rizza

MacGowan

Purcell

et al. 2012

Mayo Clinic Proceedings

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Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.

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Section: Systemic Barriersmentioning

confidence: 99%

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

Rizza

MacGowan

Purcell

et al. 2012

Mayo Clinic Proceedings

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“…17,20,36,37,39,49–59 Direct comparisons between non-targeted and targeted approaches are scarce 17,20,54 and confounded by many other factors such as consent method, assay type, targeting criteria and assessment method, who conducts screening, and incomplete implementation. We compared the efficacy of universal and targeted screening in the context of an opt-in ED HIV screening program, hypothesizing that given full implementation and maximally permissive selection criteria, targeted screening would detect nearly as many cases while requiring many fewer tests.…”

Section: Introductionmentioning

confidence: 99%

Randomized Comparison of Universal and Targeted HIV Screening in the Emergency Department

Lyons¹,

Lindsell²,

Ruffner³

et al. 2013

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective Universal HIV screening is recommended but challenging to implement. Selectively targeting those at risk is thought to miss cases, but prior studies are limited by narrow risk criteria, incomplete implementation, and absence of direct comparisons. We hypothesized that targeted HIV screening, when fully implemented and using maximally broad risk criteria, could detect nearly as many cases as universal screening with many fewer tests. Methods This single-center, cluster-randomized trial compared universal and targeted patient selection for HIV screening in a lower prevalence urban emergency department. Patients were excluded for age (<18, >64), known HIV infection, or prior approach for HIV testing that day. Targeted screening was offered for any risk indicator identified from charts, staff referral, or self-disclosure. Universal screening was offered regardless of risk. Baseline seroprevalence was estimated from consecutive de-identified blood samples. Results There were 9,572 eligible visits during which the patient was approached. For universal screening, 40.8% (1,915/4,692) consented with six newly diagnosed (0.31%, CI95 0.13%–0.65%). For targeted screening, 37% (1,813/4,880) had no testing indication. Of the 3,067 remaining, 1,454 (47.4%) consented with 3 newly diagnosed (0.22%, CI95 0.06%–0.55%). Estimated seroprevalence was 0.36% (CI95 0.16%–0.70%). Targeted screening had a higher proportion consenting (47.4% v. 40.8%, p<0.002), but a lower proportion of ED encounters with testing (29.7% v. 40.7%, p<0.002). Conclusions Targeted screening, even when fully implemented with maximally permissive selection, offered no important increase in positivity rate or decrease in tests performed. Universal screening diagnosed more cases, because more were tested, despite a modestly lower consent rate.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Shih

Hsu

et al. 2015

Jpn J Infect Dis

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Using Nonrapid HIV Technology for Routine, Opt-out HIV Screening in a High-Volume Urban Emergency Department

Cited by 54 publications

References 15 publications

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

Randomized Comparison of Universal and Targeted HIV Screening in the Emergency Department

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

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