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Study objectiveWe describe outcomes of a rapid HIV testing program integrated into emergency department (ED) services, using existing staff. MethodsFrom April 2005 through December 2006, triage nurses in an urban ED offered HIV screening to medically stable patients aged 12 years or older. Clinicians could also order diagnostic testing according to presenting signs and symptoms and suspicion of HIV-related illness. Nurses obtained consent, performed rapid testing, and disclosed negative test results. Clinicians disclosed positive test results and arranged follow-up. Outcome measures included number and proportion of visits during which screening was offered, accepted, and completed; number of visits during which diagnostic testing was completed; and number of patients with confirmed new HIV diagnosis and their CD4 counts. ResultsHIV screening and diagnostic testing were completed in 9,466 (8%) of the 118,324 ED visits (14.2% of the 60,306 unique patients were tested at least once). Screening was offered 45,159 (38.2%) times, accepted 21,626 (18.3%) times, and completed 7,923 (6.7%) times; diagnostic testing was performed 1,543 (1.3%) times. Fifty-five (0.7%) screened patients and 46 (3.0%) of those completing diagnostic testing had confirmed positive HIV test results. Median CD4 count was 356 cells/μL among screened patients and 99 cells/μL among those who received diagnostic testing. ConclusionAlthough existing staff was able to perform HIV screening and diagnostic testing, screening capacity was limited and the HIV prevalence was low in those screened. Diagnostic testing yielded a higher percentage of new HIV diagnoses, but screening identified greater than 50% of those found to be HIV positive, and the median CD4 count was substantially higher among those screened than those completing diagnostic testing. a Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA b Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Provide feedback on this article at the journal's Web site, www.annemergmed.com. Supervising editor: David A. Talan, MD Author contributions: DAEW, JDS, BMB, and JDH conceived and designed the study. ANS acquired the data. DAEW, ANS, JDS, BMB, and JDH analyzed and interpreted the data. DAEW and ANS drafted the article, and all authors contributed substantially to its revision. Statistical analysis was provided by Barbara Grimes, PhD, University of California at San Francisco, Department of Epidemiology and Biostatistics (paid consultant). DAEW obtained the funding and takes responsibility for the paper as a whole. Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Supported by grant PSU65/CCU924486 from the Centers for Disease Control and Prevention and by grant 1 UL1 RR024131-01 from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The findings and conclusions in this publication are those of the authors and do not necessarily represent the views of the CDC or of the NCRR. Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com. Publication date: Available online November 5, 2008. Reprints not available from the authors. PII: S0196-0644(08)01844-1 doi:10.1016/j.annemergmed.2008.09.027 © 2008 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
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ABSTRACT
Results of a Rapid HIV Screening and Diagnostic Testing Program in an Urban Emergency Department
Emergency Department–Based HIV Testing: Too Little, but Not Too Late
