Making the Case: Cost-Effectiveness and Feasibility
Early studies have found that HIV testing is feasible in busy, urban EDs.(20, 25, 33, 36, 38) The table below highlights findings from these studies.
|Coil, Haukoos et al. 2004(32)||Referral to
|High / ED||11% of patients
|Glick, Silva et al. 2004(33)||Risk targeted||High / ED||55%||40%||3%|
|Kelen, Hexter et al. 1996(25)||Risk targeted||High / ED||84%||62%||16%|
|Kelen, Shahan et al. 1999(20)||Universal Offer||High / ED||48%||NA||5.4%|
|Kendrick, Kroc et al. 2002(42)||Universal Offer||High / ED||27%||98%||2.8%|
|Lyons, Lindsell et al. 2005(36)||Risk targeted||Low / ED||64%||75-77%||0.7%|
|Lyss, Branson et al. 2007(37)||Screening||High / ED||42%||NA||1.2%|
|Lyss, Branson et al. 2007(37)||Provider Referral||High / ED||95%||NA||11.6%|
|Walensky, Losina et al. 2005(38)||Universal Offer||High /
Some sites have demonstrated that even with modest resources (e.g., $75,000(33) to $141,975(20) for risk-based testing and $232,000(38) for routine testing), the numbers they test and HIV infections they identify are equal to or surpass benchmarks in community-based settings.(35, 38, 42)
A major consideration in the effectiveness of ED-based HIV testing is for patients to actually receive their results and be connected to care. When follow-up is required — such as when providers refer patients to outpatient HIV testing or when patients have to return for test results — adherence is poor and testing is ineffective.(27, 32) Intensive follow-up with patients to deliver test results is one approach that has been effective.(36) Another is the use of rapid HIV tests in which results can be available at a single visit. Rates of patient consent to rapid testing are comparable to those for standard testing.(20)
25. Kelen GD, Hexter DA, Hansen KN, et al. Feasibility of an emergency department-based, risk-targeted voluntary HIV screening program. Annals of Emergency Medicine. Jun 1996;27(6):687-692.
27. Goggin MA, Davidson AJ, Cantril SV, O'Keefe LK, Douglas JM. The extent of undiagnosed HIV infection among emergency department patients: results of a blinded seroprevalence survey and a pilot HIV testing program. Journal of Emergency Medicine. Jul 2000;19(1):13-19.
32. Coil CJ, Haukoos JS, Witt MD, Wallace RC, Lewis RJ. Evaluation of an emergency department referral system for outpatient HIV testing. Journal of Acquired Immune Deficiency Syndromes: JAIDS. Jan 1 2004;35(1):52-55.
33. Glick NR, Silva A, Zun L, Whitman S. HIV testing in a resource-poor urban emergency department. AIDS Education and Prevention. 2004;16(2):126.
35. Lyons MS, Lindsell CJ, Ledyard HK, Frame PT, Trott AT. Health department collaboration with emergency departments as a model for public health programs among at-risk populations. Public Health Reports. May-June 2005;120:259-265.
36. Lyons MS, Lindsell CJ, Ledyard HK, Frame PT, Trott AT. Emergency department HIV testing and counseling: an ongoing experience in a low-prevalence area. Annals of Emergency Medicine. Jul 2005;46(1):22-28.
37. Lyss SB, Branson BM, Kroc KA, Couture EF, Newman DR, Weinstein RA. Detecting unsuspected HIV infection with a rapid whole-blood HIV test in an urban emergency department. J Acquir Immune Defic Syndr. 2007;44(4):435-442.
38. Walensky RP, Losina E, Malatesta L, et al. Effective HIV case identification through routine HIV screening at urgent care centers in Massachusetts. American Journal of Public Health. Jan 2005;95(1):71-73
42. Kendrick SR, Kroc KA, Couture E, Weinstein RA. Comparison of point-of-care rapid HIV testing in three clinical venues. AIDS. Nov 5 2004;18(16):2208-2210.
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