Making the Case: The Scope of Nationwide HIV Testing in EDs

According to a 2004 hospital survey, 57 percent of hospitals provide HIV tests in their emergency departments.(28) To date, routine testing for HIV in EDs has been close to nonexistent,(28, 29) even for patients with sexually transmitted diseases.(28, 30) Most hospitals provide HIV testing in cases of occupational exposure or at the provider's discretion based on clinical presentation or other risk factors.(28)

While levels of HIV testing in EDs are low, there is reason to believe that the number of EDs that provide HIV testing will grow significantly over the next few years. For example, a small number of EDs have piloted HIV testing and have published their findings.(20, 24, 25, 27, 31-38) Some health departments, including those in Massachusetts,(38) Ohio,(35) New Jersey,(39) and Michigan(40) are collaborating with EDs and urgent care settings to offer HIV testing. The Society of Academic Emergency Medicine's 2007 annual meeting has a number of presentations focused on ED-based HIV testing.(41)

Cites Sources

20. Kelen GD, Shahan JB, Quinn TC. Emergency department-based HIV screening and counseling: experience with rapid and standard serologic testing. Annals of Emergency Medicine. Feb 1999;33(2):147-155.
24. Kelen GD, Hexter DA, Hansen KN, Tang N, Pretorius S, Quinn TC. Trends in human immunodeficiency virus (HIV) infection among a patient population of an inner-city emergency department: implications for emergency department-based screening programs for HIV infection. Clinical Infectious Diseases. Oct 1995;21(4):867-875.
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.
28. Williams Torres G, Hasnain-Wynia R, Whitmore H, Pickreign J, Stanger JK. Hospital HIV Testing Policies and Practices: A National Survey: Health Research and Educational Trust; 2005.
29. Wilson SR, Mitchell C, Bradbury DR, Chavez J. Testing for HIV: current practices in the academic ED. American Journal of Emergency Medicine. Jul 1999;17(4):354-356.
30. Fincher-Mergi M, Cartone KJ, Mischler J, Pasieka P, Lerner EB, Billittier A. Assessment of emergency department health care professionals' behaviors regarding HIV testing and referral for patients with STDs. AIDS Patient Care & Stds. Nov 2002;16(11):549-553.
31. Centers for Disease Control and Prevention. Routinely recommended HIV testing at an urban urgent-care clinic - Atlanta, Georgia, 2000. Morbidity and Mortality Weekly Report. 2001;50(25):538.
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.
34. Haukoos JS, Witt MD, Zeumer CM, Lee TJ, Halamka JD, Lewis RJ. Emergency department triage of patients infected with HIV. Academic Emergency Medicine. 2002;9(9):880.
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.
39. Paul SM, Cadoff E, Martin E, et al. Rapid HIV Testing in Emergency Departments: A Successful New Jersey Initiative. Prevention Health Week. New Brunswick; 2005.
40. Randall L. Personal communication. Michigan Department of Community Health; 2006: Key informant interview.
41. 2007 Society for Academic Emergency Medicine Annual Meeting Abstracts. Academic Emergency Medicine. 2007;14(5, Supplement 1).

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