Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 65-71 , July 2009

Emergency Department–Based HIV Testing: Too Little, but Not Too Late

  • Gabor D. Kelen, MD

      Affiliations

    • Corresponding Author InformationAddress for correspondence: Gabor D. Kelen, MD, The Johns Hopkins University School of Medicine, 1830 E Monument St, Ste 600, Baltimore, MD 21205
    • ,
  • Richard E. Rothman, MD, PhD

References 

  1. Branson BM. Revised recommendations for HIV testing in healthcare settings in the US. http://www.cdc.gov/hiv/topics/testing/resources/slidesets/pdf/testing_healthcare.pdfAccessed March 1, 2009
  2. Centers for Disease Control and Prevention. HIV prevalence estimates, United States, 2006. MMWR Morb Mortal Wkl Rep. 2008;57:1073–1077
  3. Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003. Abstract presented at: National HIV Prevention Conference; June 12-15 2005;Atlanta, GA
  4. Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006;20:1447–1450
  5. Centers for Disease Control and Prevention. Estimated numbers of AIDS cases, by year of diagnosis and selected characteristics, 2002-2006 and cumulative—United States and dependent areas. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006report/table3.htmAccessed March 1, 2009
  6. Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300:520–529
  7. Baker J, Kelen GD, Sivertson KT, et al. Unsuspected human immunodeficiency virus (HIV) in critically ill emergency patients. JAMA. 1987;257:2609–2611
  8. 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
  9. 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
  10. Centers for Disease Control and Prevention. Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings. MMWR Morb Mortal Wkly Rep. 1993;42:1–6(RR-02)
  11. White DE, Scribner AN, Schulden JD, et al. Results of a rapid HIV screening and diagnostic testing program in an urban emergency department. Ann Emerg Med. 2009;54:56–64
  12. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Morb Mortal Wkly Rep. 2006;55:1–17(RR-14)
  13. Clark SJ, Kelen GD, Henrard DR, et al. Unsuspected primary human immunodeficiency virus type infection in seronegative emergency department patients. J Infect Dis. 1994;170:194–197
  14. Kelen GD, Hexter DA, Hansen KN, et al. Trends in human immunodeficiency virus (HIV) infection among a patient population of an inner-city emergency department: implications for emergency department-based screening programs for HIV infection. Clin Infect Dis. 1995;21:867–875
  15. 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
  16. Kelen GD, Shahan JB, Quinn TC Project Educate Workgroup. Emergency department-based HIV screening and counseling: experience with rapid and standard serologic testing. Ann Emerg Med. 1999;33:147–155
  17. Centers for Disease Control and Prevention. Revised guidelines for HIV counseling, testing, and referral. MMWR Morb Mortal Wkly Rep. 2001;50:1–62
  18. Hsieh Y-H, Rothman RE, Newman-Toker DE, et al. National estimation of rates of HIV serology testing in US emergency departments 1993-2005: baseline prior to the 2006 Centers for Disease Control and Prevention recommendations. AIDS. 2008;22:2127–2134
  19. Ehrenkranz PD, Ahn CJ, Metlay JP, et al. Availability of rapid human immunodeficiency virus testing in academic emergency departments. Acad Emerg Med. 2008;15:144–150
  20. Hardwicke R, Malecha A, Lewis ST, et al. HIV testing in emergency departments: a recommendation with missed opportunities. J Assoc Nurse AIDS Care. 2008;19:211–218
  21. Rothman R. Current Centers for Disease Control and Prevention guidelines for HIV counseling, testing, and referral: critical role of and a call to action for emergency physicians. Ann Emerg Med. 2004;44:31–42
  22. Burke R, Sepkowitz K, Bernstein K, et al. Why don't physicians test for HIV? (a review of the US literature). AIDS. 2007;21:1617–1624
  23. Brown J, Shesser R, Simon G. Establishing an ED HIV screening program: lessons from the front lines. Acad Emerg Med. 2007;14:658–661
  24. Kelen G. Public health initiatives in the emergency department: not so good for the public health?. Acad Emerg Med. 2008;15:194–197
  25. Torres G, Holtgrave D, Lindsell C, et al. Perceived public health and clinical impact of emergency department based HIV testing: expert perspectives from the 2007 conference of the National Emergency Department HIV Testing Consortium. Abstract presented at: 2008 National Summit on HIV Diagnosis, Prevention and Access to Care; November 2008; Arlington, VA.
  26. Hsieh Y-H, Jung J, Shahan J, et al. Outcomes and cost analysis of three operational models for rapid HIV testing services in an academic inner-city emergency department [abstract]. Presented at the 2008 National Summit on HIV Diagnosis, Prevention and Access to Care; November 2008; Arlington, VA.
  27. Centers for Disease Control and Prevention. Missed opportunities for earlier diagnosis of HIV infection—South Carolina, 1997-2005. MMWR Morb Mortal Wkly Rep. 2006;55:1269–1272
  28. Bartlet JG, Branson BM, Fenton K, et al. Opt-out testing for human immunodeficiency virus in the United States. JAMA. 2008;200:945–951
  29. Irvin CB, Wyer PC, Gerson LW Society for Academic emergency Medicine Public Health and Education Task Force Preventive Service Work Group. Preventive care in the emergency department, part II: clinical preventive services—an emergency medicine evidence-based review. Acad Emerg Med. 2008;7:1042–1054
  30. Lyons M, Lindsell C, Ledyard HK, et al. Emergency department HIV testing and counseling: an ongoing experience in a low-prevalence area. Ann Emerg Med. 2005;46:22–28
  31. Haukoos J, Hopkins E, Eliopoulos V, et al. Development and implementation of a model to improve identification of patients infected with HIV using diagnostic rapid testing in the emergency department. Acad Emerg Med. 2007;14:1149–1157
  32. Kraus CK, Shahan JB, Rothman RE, et al. Twenty years experience with HIV testing among emergency department patients at the Johns Hopkins Hospital. Abstract presented at: 2008 National Summit on HIV Diagnosis, Prevention and Access to Care; November 2008; Arlington, VA.
  33. Committee on the Future of Emergency Care in the United States Health System. Future of Emergency Care Series: Hospital-Based Emergency Care at the Breaking Point. Washington, DC: National Academies Press; 2006;
  34. Pines JM, Hollander JE, Localio R, et al. The association between emergency department crowding and hospital performance on antibiotic timing for pneumonia and percutaneous myocardial infarction. Acad Emerg Med. 2006;13:873–878
  35. Schull MJ, Vermeulen MJ, Stukel TA. The risk of missed diagnosis of acute myocardial infarction associated with emergency department volume. Ann Emerg Med. 2006;48:647–655
  36. Schull MJ, Vermeulen MJ, Slaughter G, et al. Emergency department crowding and thrombolysis delays in acute myocardial infarction. Ann Emerg Med. 2004;44:577–585
  37. Pines JM, Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51:1–5
  38. Lyons MS, Lindsell CJ, Haukoos JS, et al. Nomenclature and definitions for emergency department human immunodeficiency virus (HIV) testing: report from the 2007 conference of the National Emergency Department HIV Testing Consortium. Acad Emerg Med. 2009;16:168–177
  39. ACEP Board of Directors. ACEP policy statements (HIV testing and screening in the emergency department). April 2007 http://www.acep.org/practres.aspx?id=29512Accessed March 10, 2009
  40. US Department of Health and Human Services. HHS proposes nearly $700 billion budget for fiscal year 2008 (News release Monday, February 5, 2007). http://www.dhhs.gov/news/press/2007pres/02/20070205a.htmlAccessed March 13, 2009
  41. Chibbaro L. Obama to boost domestic AIDS spending in 2010. http://www.cdcnpin.org/news/NewsList.aspAccessed March 10, 2009
  42. Kendrick S. Impact of rapid HIV testing in 3 public venues. Abstract presented at the 40th annual meeting of the Infectious Diseases Society of America, Chicago, IL, October 2002.
  43. Kelen GD, Chanmugam A, Meyer WA, et al. Detection of HIV-1 by polymerase chain reaction and culture in seronegative intravenous drug users in an inner-city emergency department. Ann Emerg Med. 1993;22:769–775
  44. Kelen GD, Shahan J, Quinn TC. Emergency department-based HIV screening and counseling: experience with rapid and standard serologic testing. Ann Emerg Med. 1999;33:147–155
  45. Goggin M, Davidson A. The extent of undiagnosed HIV infection among emergency department patients: results of a blinded seroprevalence survey and a pilot HIV testing program. J Emerg Med. 2000;19:13–19
  46. Glick N, Sila A, Zun L, et al. HIV testing in a resource-poor urban emergency department. AIDS Educ Prev. 2004;16:126–136
  47. Lyons M, Lindsell C, Ledyard H. Health department collaboration with emergency departments as a model for public health programs among at-risk populations. Public Health Rep. 2005;120:259–265
  48. Lyss S, Branson B, Kroc KA, et al. Detecting unsuspected HIV infection with a rapid whole-blood HIV test in an urban emergency department. J AIDS. 2007;44:435–442
  49. Mehta S, Hall J, Lyss SB, et al. Adult and pediatric emergency department sexually transmitted disease and HIV screening: programmatic overview and outcomes. Acad Emerg Med. 2007;14:250–258
  50. Calderon Y, Haughey M, Leider J, et al. Increasing willingness to be tested for human immunodeficiency virus in the emergency department during off-hour tours: a randomized trial. Sex Transm Dis. 2007;34:1025–1029
  51. Silva A, Glick N, Lyss S, et al. Implementing an HIV and sexually transmitted disease screening program in an emergency department. Ann Emerg Med. 2007;49:564–572
  52. Merchant R, Seage G, Mayer KH, et al. Emergency department patient acceptance of opt-in, universal, rapid HIV screening. Public Health Rep. 2008;123(suppl 3):27–40
  53. Mollen C, Lavelle J, Hawkins L, et al. Description of novel pediatric emergency department-based HIV screening program for adolescents. AIDS Patient Care STDS. 2008;22:505–512
  54. Brown J, Shesser R, Simon G, et al. Routine HIV screening in the emergency department using the new US Centers for Disease Control and Prevention guidelines: results from a high-prevalence area. J AIDS. 2007;46:395–401
  55. Walensky R, Arbelaez C, Reichmann WM, et al. Revising expectations from rapid HIV tests in the emergency department. Ann Intern Med. 2008;149:153–160
  56. Brown J, Kuo I, Bellows J, et al. Patient perceptions and acceptance of routine emergency department HIV testing. Public Health Rep. 2008;123(suppl 3):21–26

 Supervising editor: David A. Talan, MD

 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. Dr. Rothman is funded by the Maryland Department of Health and Mental Hygiene and the Maryland AIDS Administration via a CDC grant.

 Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com.

 Publication date: Available online April 24, 2009.

 Reprints not available from the authors.

PII: S0196-0644(09)00361-8

doi: 10.1016/j.annemergmed.2009.03.027

Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 65-71 , July 2009

Article Tools