Casting a Wider Net – Routine Screening and Identifying HIV-positive Persons in Emergency Departments

Issues: Traditionally, prevention-funded HIV testing has occurred in risk-based-testing programs (RBTP). However, approximately 20% of persons living with HIV (PLWH) are unaware of their disease and account for > 54% of new sexual transmissions. The adoption of new testing strategies is needed to identify these persons; routine screening programs (RSP) in healthcare settings, notably emergency departments (ED), are  key  to identify PLWH, including those who are unaware of their HIV infection and do not seek testing.

Description: To evaluate the effectiveness of RSPs in EDs, data from surveillance was matched from RSP-EDs and compared to RBTPs for the period 2011-2012. Sites included five RSP-EDs located in areas of the state with the highest HIV prevalence and 34 RBTPs statewide, including local health departments, STD clinics and community based organizations. 

Lessons Learned: Findings include twice as many HIV-infected women identified in RSP-EDs compared to RBTPs (24% versus 12%), and almost 70% of the HIV-infected cases in RSP-EDs were > 35 years versus 65% in the RBTPs were < 34 years.  The RBTPs identified 79% men who have sex with men compared to 39% in RSP-EDs, while RSP-EDs identified 10% injection drug users compared to 2% in RBTPs.

Recommendations: These findings confirm that RSP-EDs are diagnosing PLWH who are unaware of their risk of acquiring HIV, plus those who may not access RBTPs or medical care and disclose risk. These programs have the potential to increase the number of PLWH who know their HIV status and reduce the number of new infections.

Learning Areas:

Implementation of health education strategies, interventions and programs

Learning Objectives:
Discuss the role of routine HIV screening in emergency departments in reducing the number of new HIV infections.

Keyword(s): HIV/AIDS, Health Systems Transformation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Ms. Clark serves as a subject matter expert for Texas DSHS HIV/STD Prevention and Care Branch on testing technologies, reimbursement practices, and state laws/rules associated with HIV testing in Texas. She provides advanced consultative services and technical assistance to support the adoption of routine HIV testing in health care settings working with contractors and manages projects on integrating sustainable HIV testing in emergency centers, primary care and community health centers.
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.

Back to: 4137.0: Innovations in HIV Testing Strategies and Technologies