Increased rates of rapid point-of-care HIV testing using patient care technicians to perform tests in the ED (original) (raw)
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PLOS ONE, 2019
Introduction HIV testing guidelines are poorly implemented in most clinical settings. The best screening strategy and healthcare scenario are still unknown. The aim of our study is to evaluate the impact of a structured HIV testing intervention (DRIVE), compared to HIV testing as routinely performed in clinical practice, in two different clinical settings: a primary care center and an emergency department. Methods Prospective evaluation of an HIV testing strategy in two clinical settings from the same healthcare area. The DRIVE program included trained nurse practitioners to perform the screening, a questionnaire to assess the risk of exposure and HIV indicator conditions (RE&IC), and rapid HIV tests. The main variables between the DRIVE program and clinical practice were the absolute number of newly diagnosed HIV infections and testing coverage. Results The DRIVE program included 5,329 participants, of which 51.2% reported at least one positive answer in the questionnaire. The estimated HIV testing coverage was significantly higher in the DRIVE program than in the routine clinical practice (7.17% vs. 0.96%, p < 0.001), and was better in the primary care center than in the emergency department with the two strategies. Twenty-two HIV-positive people were identified, with a rate of 8.6‰ in the emergency department vs. 2.2‰ in the primary care center (p = 0.001). A higher rate of new PLOS ONE |
HIV Testing in Emergency Departments: A Recommendation With Missed Opportunities
Journal of the Association of Nurses in AIDS Care, 2008
The purpose of this study was to determine the effective use of the 2001 Centers for Disease Control and Prevention (CDC) HIV testing recommendations in emergency department settings. A postal questionnaire was distributed to health care providers in emergency departments across the United States to evaluate the rate HIV tests are routinely offered to individuals presenting to emergency departments for care. A total of 223 emergency department providers responded. Results indicated that health care providers generally were not aware that their institutions were located in areas with high HIV seroprevalence rates. Only 3% of the health care providers surveyed claimed they routinely offered an HIV test to everyone who sought care in their emergency department regardless of patients' presentation to care. The conclusion was that, in 2004, testing for HIV in emergency departments was not a priority for those providing care. In general, despite the fact that the CDC 2001 HIV testing guidelines were less universal than the 2006 recommendations, many had not implemented routine HIV testing programs in their emergency departments. The number of patients who use emergency departments for routine care is on the rise, and missed opportunities for offering HIV tests have detrimental effects for the individual as well as for the public health.
A Comparison of HIV Testing in the Emergency Department and Urgent Care
The Journal of Emergency Medicine, 2010
e Abstract-Background: Although national guidelines recommend universal human immunodeficiency virus (HIV) testing, emergency departments (EDs) may choose to limit testing to certain patients, such as those triaged to urgent care (UC). Objective: To compare the results of rapid HIV testing in an urban ED with an affiliated UC. Methods: This was a retrospective analysis of an HIV testing program that included screening, which was initiated by triage nurses, and diagnostic testing, which was initiated by clinicians. Eligible patients were > 12 years old and medically stable. Results: From April 2005 through December 2006, HIV tests were completed in 6196 (8.3%) of the 74,331 ED visits and 3256 (8.8%) of the 37,169 UC visits. Screening accounted for 5009 (80.8%) of the ED tests and 2914 (89.5%) of the UC tests, and diagnostic testing accounted for the remainder. Eighty (1.3%) of the ED tests and 21 (0.6%) of the UC tests were positive (p ؍ 0.0024). Compared with newly diagnosed HIV-positive ED patients, HIV-positive UC patients were less likely to have CD4 counts < 200 cells/L (adjusted odds ratio 0.19, 95% confidence interval 0.05-0.65). Conclusion: Although the yield of HIV testing is greater among ED patients, UC patients are diagnosed at a less advanced stage of illness.
Implementation Science, 2011
Background: The 2006 Centers for Disease Control and Prevention (CDC) HIV testing guidelines recommend screening for HIV infection in all healthcare settings, including the emergency department (ED). In urban areas with a high background prevalence of HIV, the ED has become an increasingly important site for identifying HIV infection. However, this public health policy has been operationalized using different models. We sought to describe the development and implementation of HIV testing programs in three EDs, assess factors shaping the adoption and evolution of specific program elements, and identify barriers and facilitators to testing. Methods: We performed a qualitative evaluation using in-depth interviews with fifteen 'key informants' involved in the development and implementation of HIV testing in three urban EDs serving sizable racial/ethnic minority and socioeconomically disadvantaged populations. Testing program HIV prevalence ranged from 0.4% to 3.0%.
HIV Testing in the Emergency Department
Current Emergency and Hospital Medicine Reports, 2018
Purpose of Review This review explores data from the past 5 years with regard to HIV testing and diagnosis in the emergency department, as well downstream linkage to care and several adjuvant approaches. We offer perspectives on futures directions for care. Recent Findings There are many approaches to HIV testing in the ED. The largest overarching question is that of testing strategies (universal vs targeted, opt in vs out), where data is mixed and there is a lack of randomized control trials. Other studies address different aspects of ED testing, including where to integrate testing into ED workflow, and supplementary approaches such as electronic tablets. Summary In the USA, the emergency department plays a unique role in healthcare and is positioned to offer significant benefits to HIV testing and diagnosis. There are many ways to improve HIV testing rates, and we await further controlled trials to determine an optimal approach.
High-Volume Rapid HIV Testing in an Urban Emergency Department
AIDS Patient Care and STDs, 2009
New Centers for Disease Control and Prevention (CDC) guidelines recommend routine HIV screening in locations including emergency departments. This study evaluates a novel approach to HIV counseling and testing (C&T) in a high-volume inner-city emergency department in terms of the number of patients who can be recruited, tested, test positive, and are linked to care. This prospective evaluation was conducted for 26 months. Noncritically ill or injured patients presenting to an inner-city emergency department were recruited. Patients used a multimedia program that facilitated data entry and viewed previously evaluated HIV counseling videos. Demographic characteristics, risk factors, and sexual history were collected. Data were collected on the number of patients tested, number of HIV-positive patients identified, and number linked to care. Demographic characteristics of the participants were as follows: 48.7% males, mean age 32.6 AE 11.3, 34.6% Hispanic, and 37.9 % African American. Of the 7109 eligible patients approached, 6214 (87.4%) agreed to be HIV tested. There were 57 newly diagnosed or confirmed HIV-positive patients, representing a seroprevalence of 0.92%. Of those testing positive, 49 (84.2%) were linked to care and had a mean initial CD4 count of 238 cells=mm 3. In conclusion, a video-assisted rapid HIV program in a busy inner-city hospital emergency department can effectively test a high volume of patients and successfully link HIV-positive individuals to care, while providing high-quality education and prevention messages for all those who test.