Annals of Emergency Medicine
Volume 33, Issue 2 , Pages 147-155 , February 1999

Emergency Department–Based HIV Screening and Counseling: Experience With Rapid and Standard Serologic Testing

  • Gabor D Kelen, MD

      Affiliations

    • Department of Emergency Medicine
    • ,
  • Judy B Shahan, RN

      Affiliations

    • Department of Emergency Medicine
    • ,
  • Thomas C Quinn, MD

      Affiliations

    • Division of Infectious Diseases
    • Johns Hopkins University School of Medicine, Baltimore, MD; and the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
    • ,
  • The Project Educate Work Group

      Affiliations

    • Department of Emergency Medicine

Received 20 July 1998 ,Accepted 3 September 1998.

References 

  1. Centers for Disease Control and Prevention . Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings; and Technical guidance on HIV counseling. MMWR Morb Mortal Wkly Rept. 1993;42(RR-2):l-17
  2. Diaz T, Chu SY, Conti L, et al.  Health insurance coverage among persons with AIDS: Results from a multistate surveillance project. Am J Public Health. 1994;84:1015–1018
  3. Kelen GD, Hexter DA, Hansen KN, et al.  Trends in human immunodeficiency virus (HIV) infection among a patient population of an inner-city department: Implications for emergency department-based screening programs for HIV infection. Clin Infect Dis. 1995;21:267–275
  4. Risi GF, Gaumer RH, Weeks S, et al.  Human immunodeficiency virus: Risk of exposure among health care workers at a Southern urban hospital. South Med J. 1989;82:1079–1082
  5. Baraff LJ, Talan DA, Torres M. Prevalence of HIV antibody in a non–inner city university hospital emergency department. Ann Emerg Med. 1991;20:782–786
  6. Marcus R, Culver DH, Bell DM, et al.  Risk of human immunodeficiency virus infection among emergency department workers. Am J Med. 1993;94:363–370
  7. Schoenbaum EE, Weber MP. The underrecognition of HIV infection in women in an inner-city emergency room. Am J Publ Health. 1993;83:363–368
  8. Alpert PL, Shuter J, DeSchaw MG, et al.  Factors associated with unrecognized HIV-1 infection in an inner-city emergency department. Ann Emerg Med. 1996;28:159–164
  9. Medical Access Study Group . Nowhere to go: Medicaid patient access to primary care. N Engl J Med. 1994;330:1426–1430
  10. Sue D, Shahan JB, Kelen GD. Primary care access for Medicaid versus privately insured patients. [abstract] Acad Emerg Med. 1994;1:A1
  11. Ho DD. Time to hit HIV, early and Hard. [editorial] N Engl J Med. 1995;333:450–451
  12. Kaplan JE, Masur H, Holmes KK, et al.  USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: An overview. USPHS/IDSA Prevention of Opportunistic Infections Working Group. Clin Infect Dis. 1995;21(suppl 1):S12–S31
  13. Higgins DL, Galavott C, O’Reilly KR, et al.  Evidence for the effects of HIV antibody counseling and testing on risk behaviors. JAMA. 1991;266:2419–2429
  14. Chio KH, Coates TJ. Prevention of HIV infection. [editorial] AIDS. 1994;8:1371–1389
  15. Kelen GD, Fritz S, Qaqish B, et al.  Unrecognized human immunodeficiency virus infection in emergency department patients. N Engl J Med. 1988;318:1645–1650
  16. Kelen GD, DiGiovanna T, Bisson L, et al.  Human immunodeficiency virus infection in emergency department patients: Epidemiology, clinical presentations, and risk to health care workers: The Johns Hopkins experience. JAMA. 1989;262:516–522
  17. State of Maryland. Communicative Disease Bulletin. July 1991;
  18. Centers for Disease Control and Prevention . HIV Counseling, Testing and Referral: Statement and Guidelines. Atlanta, GA. US Department of Health and Human Services. May 1994;
  19. Report to the Chairman, Subcommittee on Health for Families and the Uninsured Committee on Finance, US Senate . Emergency Departments: Unevenly Affected by Growth and Change in Patient Use.. Washington DC: US General Accounting Office; 1993; GAO/HRD-93-4:20
  20. Stem RS, Weissman JS, Epstein AM. The emergency department as a pathway to admission for poor and high cost patients. JAMA. 1991;226:2238–2243
  21. Pane GA, Farner MC, Salness KA. Health care access problems of medically indigent emergency department walk-in patients. Ann Emerg Med. 1991;20:730–733
  22. Wortley PM, Chu SY, Diaz T, et al.  HIV testing patterns: Where, why, and when were persons with AIDS tested for HIV?. AIDS. 1995;9:487–492
  23. Kelen GD, Hexter DA, Hansen KN, et al.  Feasibility of an emergency department-based risk-targeted voluntary HIV screening program. Ann Emerg Med. 1996;27:687–692
  24. Irwin K, Olivo N, Schable CA, et al.  Performance characteristics of a rapid HIV antibody assay in a hospital with a high prevalence of HIV infection. Ann Intern Med. 1996;125:471–475
  25. Berrios DG, Hearst N, Coates TJ, et al.  HIV antibody testing among those at risk for infection: The National AIDS Behavioral Surveys. JAMA. 1993;270:1576–1580
  26. Centers for Disease Control and Prevention . Publicly funded HIV counseling and testing: United States. MMWR Morb Mortal Wkly Rep. 1991;20:730–733
  27. Kelen GD, Bennecoff TA, Kline R, et al.  Evaluation of two rapid screening assays for the detection of human immunodeficiency virus-1 infection in emergency department patients. publication?. Am J Emerg Med. 1991;9:416–420
  28. Kassler WJ, Dillon BA, Haley C, et al.  On-site, rapid HIV testing with same-day results and counseling. AIDS. 1997;11:1045–1051
  29. Centers for Disease Control and Prevention . Additional recommendations to reduce sexual and drug abuse-related transmission of human T-lymphotropic virus type III/lymphadenopathy-associated virus. MMWR Morb Mortal Wkly Rep. 1986;35:152–155
  30. Centers for Disease Control and Prevention . Interpretation and use of the Western blot assay for serodiagnosis of human immunodeficiency virus type 1 infections. MMWR Morb Mortal Wkly Rep. 1989;38(suppl 7):1–7
  31. Farnham PG, Gorsky RD, Holtgrave DR, et al.  Counseling and testing for HIV prevention: Costs, effects and cost-effectiveness of more rapid screening tests. Public Health Rep. 1996;111:44–54
  32. La Croix SJ, Russo G. A cost-benefit analysis of voluntary routine HIV-antibody testing for hospital patients. Soc Sci Med. 1996;42:1259–1272

☆ Address for reprints: Gabor D Kelen, MD, Department of Emergency Medicine, Johns Hopkins Hospital, Marburg B186, 600 N Wolfe St, Baltimore, MD 21287-2080; 410-955-8191, fax 410-614-1551; E-mail gkelen@.jhmi.edu.

☆☆ 0196-0644/99/$8.00 + 0   47/1/95550

PII: S0196-0644(99)70387-2

Annals of Emergency Medicine
Volume 33, Issue 2 , Pages 147-155 , February 1999

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