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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.
| Study | Type of Testing |
Prevalence / Setting |
Acceptance Rate |
Received Results |
Reactive / Positive tests |
| Coil, Haukoos et al. 2004(32) | Referral to outpatient testing |
High / ED | 11% of patients followed up |
NA | 7% |
| 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 / Urgent Care |
37% | 93% | 2% |
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)
Cited Sources
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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