Routine HIV testing in EDs linked to increased diagnoses

Programs were cost effective when compared with the economic and health costs of delayed HIV diagnoses.

Expanding routine HIV testing in emergency departments could improve HIV diagnosis rates, in turn reducing morbidity, mortality and transmission, according to researchers.

In 2006, the CDC recommended routine, voluntary testing in health care settings for patients aged 13 to 64 years. The researchers from the CDC and Johns Hopkins University, in collaboration with participating hospitals, evaluated six ED HIV testing programs to assess costs, barriers and facilitators, and to identify models during two separate periods: July 2006-December 2006 and January 2007-June 2007.

Infectious disease specialists and ED staff supported routine testing and identified staffing and resource constraints as the key barriers to supporting and expanding testing programs.

Costs averaged $11,000 per patient with HIV linked to care, which researchers said was cost effective when compared with the economic and health costs of delayed HIV diagnosis.

The researchers presented results at the 15th Conference on Retroviruses and Opportunistic Infections, held in Boston.

Hospitals participate

The investigators collected data using standardized pre-site-visit surveys and on-site interviews at facilities that had HIV testing programs for at least six months. The researchers chose sites for geographical diversity and facility type.

They evaluated two university hospital EDs, George Washington University in Washington, D.C. and the University of Cincinnati; and one city hospital ED, Metropolitan Hospital Center in New York City.

Undergraduate students offered point-of-care rapid HIV testing to patients aged 13 years and older on a voluntary, opt-out basis at the Washington ED. In Ohio, the ED used HIV counseling and testing staff for diagnostic and targeted testing using standard, laboratory-based HIV tests. Nursing staff offered laboratory-based rapid HIV testing to patients aged 13 years and older at the New York City ED.

ED patients diagnosed

In the 2006 study period, staff in the Washington ED offered tests to 4,269 patients and tested 2,526 patients. Eight patients were newly diagnosed with HIV and all were linked to care (ie, had at least one medical follow-up visit for HIV care and treatment). During the 2007 study period, staff offered tests to 2,611 patients and tested 1,300 patients. Eleven patients (0.8%) were diagnosed with HIV and all were linked to care. The program cost per newly diagnosed patient with HIV linked to care was $12,300.

In Cincinnati in 2006, staff tested 1,597 patients of the 2,781 patients offered HIV tests. Eleven patients were newly-diagnosed with HIV. During the 2007 study period, staff offered tests to 2,270 patients and tested 1,340 patients. Fourteen patients were newly-diagnosed with HIV and 12 patients were linked to care. The cost was $10,200 per patient linked to care.

In New York City, staff tested 1,743 patients of the 30,200 patients offered HIV tests during the 2006 study period. Twenty-one patients were newly-diagnosed with HIV.

During the 2007 study period, staff offered tests to 21,156 patients and tested 1,880 patients. Thirteen patients (0.7%) were newly-diagnosed with HIV and 12 were linked to care. Program costs were not available.

For more information:

• Heffelfinger J, Rothman R, Pollack H, et al. Interim findings from a multi-site evaluation of HIV testing in emergency departments. Presented at: the 15th Conference on Retroviruses and Opportunistic Infections; Feb. 3-6, 2008; Boston.