183599 Use of HIV Rapid Test Algorithms to Provide Referral to Care: Results from Two Emergency Departments

Tuesday, October 28, 2008: 2:55 PM

Brian C. Boyett, MS , Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Atlanta, GA
Douglas White, MD , Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA
Jason Haukoos, MD, MS , Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
Alicia Scribner, MPH , Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA
Emily Hopkins, MPH , Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
Kevin P. Delaney, MPH , Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Atlanta, GA
James Heffelfinger, MD, MPH , Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Atlanta, GA
     
BACKGROUND

CDC recommends performing opt-out HIV screening in healthcare settings, including emergency departments (EDs), with HIV prevalence ≥0.1%. The nature of emergency medicine (i.e., provision of acute versus ongoing healthcare) creates the need for timely HIV test results, but makes it challenging to provide confirmatory test results for patients with reactive rapid HIV test (RHT) results. With over 110 million visits to EDs annually, expanded HIV testing may result in a substantial number of false-positive RHT results. We implemented rapid test algorithms (RTAs) in two EDs to distinguish persons likely to have false-positive tests from those likely to be truly infected during a single ED visit.

METHODS

Highland Hospital ED (Oakland, CA) performed RHTs using oral fluid and, for persons with reactive tests, up to three additional RHTs using whole-blood; all tests were conducted in the ED. Denver Health Medical Center ED (Denver, CO) performed RHTs using whole-blood and, for persons with reactive tests, a second RHT using whole-blood; all tests were conducted in the hospital laboratory.

RESULTS

Of 9,964 patients tested, 58 (0.6%) had reactive RHT results on initial testing. Of these, 44 (75.9%) had reactive results on all additional RHTs and were immediately referred to HIV care; all 44 also had positive Western blots. Follow-up testing was performed on the 14 patients with discordant RHT results (n=14) and none was found to be HIV-infected.

CONCLUSIONS

RTAs correctly identified all patients with HIV infection and allowed for immediate referral to more specialized HIV care.

Learning Objectives:
1. Describe the rationale behind implementing HIV rapid test algorithms in emergency departments. 2. Assess the similarities and differences of laboratory-based versus emergency department-based (i.e., point of care) HIV rapid test algorithms. 3. Discuss the effectiveness of HIV rapid test algorithms in identifying patients truly infected with HIV.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Conducted HIV-related research at the CDC/Division of HIV/AIDS Prevention since 1999; authored or co-authored articles related to HIV/AIDS research in Journal of Infectious Diseases, Journal of Acquired Immune Deficiency Syndromes, Current Infectious Disease Reports, Morbidity and Mortality Weekly Report; authored or co-authored oral and poster presentations at Internaitonal AIDS Conference, Conference on Retroviruses and Opportunistic Infections, National HIV Prevention Conference, Infectious Disease Society of America Annual Meeting, APHA Annual Meeting, HIV Diagnostics Conference
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Learning from the Rest of the World: Development and Implementation of Rapid Test Algorithms for Point-of-Care HIV Testing in the United States
See more of: HIV/AIDS