Results From a New York City Emergency Department Rapid HIV Testing Program (original) (raw)

2010, JAIDS Journal of Acquired Immune Deficiency Syndromes

Background-The US Centers for Disease Control and Prevention recommends expanded HIV screening in emergency departments (EDs). The additional value of ED screening programs remains controversial. Methods-Patients were rapid-tested for HIV via fingerstick Oraquick in a counselor-based testing program at 2 university-hospital affiliated EDs in New York City in 2006-2007. Data were from a testing program database, supplemented by electronic medical record (EMR) review. Results-Of 2,569 ED patients who underwent rapid HIV testing, 31 were preliminary positive; all diagnoses were confirmed by Western blot (1.2%, 95%CI 0.8%, 1.7%). Seven patients had previous HIV diagnoses and 24 (0.7%, 95% CI 0.6%, 1.4%) were considered new diagnoses. Of the new diagnoses, ten had hospital visits in the year before diagnosis, 7 of whom had visited only the ED. Linkage to care, defined as a visit with an HIV provider, was documented for 17. Conclusions-ED rapid HIV testing programs can contribute substantially to HIV screening efforts and may identify persons with previously undiagnosed HIV infection who are not tested in other hospital settings. Linkage to care may be difficult, despite extensive testing program outreach. Key phrases HIV screening; rapid HIV testing; emergency department; linkage to care New York State has the highest number of HIV/AIDS cases in the country. 1 In 2006, 1,591 AIDS diagnoses in New York occurred within one year of HIV diagnosis, accounting for 35% of all new HIV diagnoses. 2 In response to this high number of late diagnoses, the advent of rapid and accurate screening tests, and a recommendation from the CDC to routinely offer HIV testing to adults in all health care settings, 3 HIV testing in New York City has expanded to the emergency department (ED). Despite recent efforts to simplify New York State legal mandates for HIV pre-test counseling and signed consent, 4 the existence of these mandates has prompted some programs to continue to rely on dedicated HIV counselors for testing in the ED. The additional value of these ED testing programs remains controversial. Our evaluation of a counselor-based ED testing program supports the premise that the ED is an important site for HIV testing because we found that patients who did not access care in other medical center settings were tested and successfully referred for follow up.