Community access to emergency department routine HIV screening

In 2006, the US Centers for Disease Control and Prevention (CDC) released new recommendations for HIV testing of Adults, Adolescents, and Pregnant Women in both the public and private sector. Among these were recommendations that emergency departments (EDs) offer routine HIV screening to their patients regardless of risk. Prince George's Hospital Center, located in Cheverly, Maryland implemented free rapid HIV screening with primary objectives of integrating HIV testing in its ED, detecting previously undiagnosed HIV infection in ED patients, linking newly diagnosed patients to care and treatment, and improving the public health of the surrounding community. This study outlines the steps taken to implement an ED-base HIV screening program in a community based hospital, servicing more than 60,000 underserved, predominantly African American patients annually in its ED. Five thousand OraQuick ADVANCE tests are expected to yield 2% or 100 new diagnoses from February – October, 2008. Maryland is one of 11 states that requires risk reduction counseling and written consent for HIV testing rather than the simpler “opt out” CDC recommendations. This study will describe the numbers and characteristics of patients screened, the rate of newly diagnosed visitors to the ED, the barriers overcome in regard to state law requiring counseling and written consent, and the feasibility of routine ED HIV testing. In addition, lessons will be learned in regards to integrating HIV screening into standard of care procedures among physicians and nurses and evaluating patients' attitudes towards HIV testing offered in the ED.