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HIV care in EDs constitutes an important strategy
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EDs around the world may be strategically important locations in the fight to end the HIV epidemic, according to findings published in EClinicalMedicine.
According to a press release, a study published in 2018 demonstrated the effectiveness of testing for HIV in EDs. Those findings suggested that introducing HIV testing in EDs provides an opportunity to identify and diagnose hard-to-reach populations.
“We are missing a key population in current HIV testing programs — young men,” Bhakti Hansoti, MBChB, PhD, MPH, associate professor of emergency medicine at Johns Hopkins School of Medicine, told Infectious Disease News. “HIV prevalence and incidence are substantially higher among young men than what is reported in national surveys, which means this population is a hot spot for HIV infection that is currently missed and needs to be targeted.”
To build on these findings, researchers conducted a cross-sectional observational study among three different EDs in the Eastern Cape province of South Africa — which has reported the world’s highest number of recorded HIV infections — to determine the current burden of HIV among patients in the ED. Between June 2017 and July 2018, all adult, noncritical patients aged 18 to 70 years were offered a point-of-care HIV test. From there, all HIV-positive patients were tested for the presence of ART and viral suppression.
HIV status was recorded for 2,901 patients, of which 28% were HIV-positive. Among those who were HIV-positive, 28.9% were newly diagnosed. For women, the incidence of HIV was estimated to be 4.5/100 person years (95% CI, 2.4-6.5), whereas the incidence among men was estimated at 1.5/100 person-years (95% CI, 0.5-2.5). Specifically, HIV prevalence among women was 35.3% compared with 20.7% among men. Moreover, women aged 36 to 45 had the highest burden; almost 65% were identified as HIV positive.
According to the study, 54% of all HIV-positive individuals tested positive for the presence of ART. Moreover, 49% with viral load data were virally suppressed. These numbers are significantly below the UNAIDS 90-90-90 target goals, according to the release.
“The ED is a complex clinical environment and little is known about the ED population in South Africa, which has a high volume of men with trauma-related issues,” Hansoti said. “We simply don’t know how best to integrate HIV testing into the ED and, if we do, how likely patients in the ED are to accept testing and start treatment if they test positive. In order to make a sustainable impact on the HIV epidemic, we need to develop an implementation science approach to testing.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.
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