Identifying Out-of-Care, Known HIV+ Patients with a 4th Generation HIV Testing Platform

Routine, lab-based 4^th generation testing platforms enhance emergency department (ED) HIV testing capacity by resulting tests in 1 hour. Additionally, 4^th generation testing can identify known HIV+ patients and their care management status. This study evaluates the impact of a 4^th generation ED screening program on the identification of out-of-care, known HIV+ patients.

We conducted a retrospective review of the HIV testing program 15 months before and after converting from a weekday-only, 8am-11pm point-of-care testing procedure to a 7/24 lab-based 4^th generation program (4/2012-9/2014). Patients who did not self-report a history of HIV were tested. Patients with positive tests were categorized as previously undiagnosed or known HIV+. An HIV specialist offered linkage to care to any out-of-care, known HIV+ patients.

The number of known HIV+ individuals identified in the ED increased from 341 before the 4^th generation testing to 551 in the 15 months after. The expanded test hours (from 11pm-8am) was the main contributor to the increased numbers. Out-of-care, known HIV+ patients were more likely to be identified through the testing mechanism than the self-disclosure route (50% vs. 22%, p<0.001) and 40% of these patients attended at least one HIV-specific outpatient clinic visit. Among the tested individuals, the mean age was 43.5 years, 87% male, 32% were African-American and 48% Latino.

4^th Generation testing increased the likelihood of identifying out-of-care, known HIV+ patients in an ED setting. Although re-establishing care among this cohort remains challenging, the testing algorithm allows the re-identification of these patients and possibly linkage to care.