Online Program

Do emergency departments represent a window of opportunity to identify otherwise undiadnosed HIV infections?

Wednesday, November 6, 2013 : 12:30 p.m. - 12:45 p.m.

Carolyn Nganga-Good, RN MS CPH, Bureau of HIV/STD Prevention, Baltimore City Health Department, baltimore, MD
Hilda Ndirangu, MHS CPH, Bureau of HIV/STD Prevention, Baltimore City Health Department, baltimore, MD
Ravikiran Muvva, MBBS MPH MPA, Bureau of HIV/STD Prevention, Baltimore City Health Department, baltimore, MD
Rafiq Miazad, MD MPH, Bureau of HIV/STD Prevention, Baltimore City Health Department, baltimore, MD
Patrick Chaulk, MD, MPH, Bureau of HIV/STD Prevention, Baltimore City Health Department, Baltimore, MD
Issue: Baltimore has historically experienced high HIV rates. Innovative, evidence-based testing strategies have increased the number of persons aware of their HIV status and improved referrals to treatment services. Urban populations often use emergency departments (ED) for primary care, thus presenting a window of opportunity to test those missed through other testing efforts. Routine testing in an ED setting may be ideal for identifying those who may not be perceived as high-risk and are unaware of their status. Description: In 2008, the Health Department implemented routine HIV testing programs in seven EDs. Outreach, partner services, linkage-to-care, re-linkage, and referral to prevention and support services are part of the comprehensive services provided. Data collected from these testing sites (2008-2011) were analyzed to determine outcomes. Lessons Learned: 56,600 tests have been conducted since 2008 with 334 (0.59%) confirmed positives. Of these, 261 (0.46%) were newly diagnosed and 171 (66%) were linked to care. The majority of those tested, self-reported not being previously tested or diagnosed with HIV. Positivity rates have declined from 1.11% in 2008 to 0.41% in 2011 despite high testing volumes. Further evaluation is needed to identify the potential reasons for the decreasing positivity rates. Recommendations: ED routine testing reaches population often missed by other testing services, promoting HIV status awareness, early diagnosis and treatment, which can result in lower transmission and mortality rates, increased years of productivity, and cost savings. This unique program has policy implications for expanding opt-out routine HIV testing in healthcare settings and pertinent third-party reimbursement.

Learning Areas:

Advocacy for health and health education
Implementation of health education strategies, interventions and programs
Program planning
Provision of health care to the public
Public health or related public policy

Learning Objectives:
Discuss the importance of emergency departments in identifying new HIV infections Demonstrate the importance of routine HIV testing and the need to engage healthcare providers at all levels and settings Demonstrate the feasibility of providing comprehensive services such as testing, linkage to care, partner services, referrals to prevention and support services in healthcare settings

Keyword(s): HIV/AIDS, Emergency Department/Room

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been managing the emergency department program since its inception and currently manage all its partners. This involves grant writing,budget and contract management, program monitoring and reporting, training and providing technical assistance and capacity building. My interests are in capacity building, program planning and evaluation, and health system strengthening.
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.