Monitoring HIV Testing at Visits to Emergency Departments in the United States: Very-Low Rate of HIV Testing

National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 09/2012; 62(1). DOI: 10.1097/QAI.0b013e3182742933
Source: PubMed


BACKGROUND:: Early diagnosis and treatment of HIV infection results in improved clinical outcomes and decreased transmission, yet many infected persons are unaware of their infection or diagnosed late. The Centers for Disease Control and Prevention (CDC) recommends routine opt-out testing of all persons aged 13-64 in high prevalence settings. STUDY OBJECTIVE:: To describe methods to estimate HIV testing rates at visits to emergency departments (EDs) for monitoring adherence to recommendations for opt-out testing. METHODS:: We analyzed data from the 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS). In 2009, two questions were added to the survey about HIV status and testing. We estimated the frequency of HIV testing at ED visits made by persons aged 13-64 years not known to be HIV infected. RESULTS:: In 2009, 90.5 million visits were made to EDs, including 60.0% by whites, 24.5% by blacks, and 12.1% by Hispanics; and 38.4% by privately insured, 25.7% by Medicaid insured, and 21.4% by uninsured persons. Among 89.9 million visits by patients not known to be HIV infected, HIV testing was performed at only 0.2% of visits. Among 3.4 million visits made by persons in whom targeted testing is recommended-those with increased risk for HIV and other sexually transmitted diseases, or pregnancy-only 2.3% were tested for HIV. CONCLUSIONS:: NHAMCS can be a useful tool to monitor trends in HIV testing in U.S. emergency departments. A high proportion of visits to EDs in the United States were made by persons in historically medically underserved populations and routine HIV testing was a rare event during ED visits.

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    • "In the more anonymous and accessible emergency department (ED) setting, adoption of non-targeted screening policies has been limited by time, concerns about follow up of test results, and competing priorities. Previous studies have demonstrated significant increases in detecting undiagnosed HIV with non-targeted, rapid HIV tests in the ED setting [5,6], yet only about 25% of eligible patients complete testing in these studies [3,7-9]. In settings without explicit opt-out screening protocols, there were far lower rates of screening, such as the 1.5% overall screening rate observed within the 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS) data [4]. "
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    ABSTRACT: Introduction Despite recommendations by the Centers for Disease Control (CDC) that all adults be offered non-targeted HIV screening in all care settings, screening in acute-care settings remains unacceptably low. We performed an observational study to evaluate an HIV screening pilot in an academic-community partnership health center urgent care clinic. Methods We collected visit data via encounter forms and demographic and laboratory data from electronic medical records. A post-pilot survey of perceptions of HIV screening was administered to providers and nurses. Multivariable analysis was used to identify factors associated with completion of testing. Results Visit provider and triage nurse were highly associated with both acceptance of screening and completion of testing, as were younger age, male gender, and race/ethnicity. 23.5% of patients completed tests, although 36.0% requested screening; time constraints as well as risk perceptions by both the provider and patient were cited as limiting completion of screening. Post-pilot surveys showed mixed support for ongoing HIV screening in this setting by providers and little support by nurses. Conclusions Visit provider and triage nurse were strongly associated with acceptance of testing, which may reflect variable opinions of HIV screening in this setting by clinical staff. Among patients accepting screening, visit provider remained strongly associated with completion of testing. Despite longstanding recommendations for non-targeted HIV screening, further changes to improve the testing and results process, as well as provider education and buy-in, are needed to improve screening rates.
    AIDS Research and Therapy 08/2014; 11(1):24. DOI:10.1186/1742-6405-11-24 · 1.46 Impact Factor
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    • "As such, the newest recommendations expand testing to the broadest possible population. Guidelines have not yet been incorporated nationwide, and routine testing remains the exception not the rule in emergency room settings (Johnson et al, 2011; Hoover et al, 2012) not all healthcare professionals are well versed in the new recommendations (Mohajer et al, 2012) or do not recommend testing according to the guidelines (Berkenblit et al, 2012). Widespread implementation will be essential for overall success of this approach. "
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    ABSTRACT: Over the last thirty years, the human immunodeficiency virus (HIV) epidemic has matured. In the United States, HIV has changed from an explosive outbreak to an endemic disease; currently, an estimated 1.1 million people are infected with HIV, including a substantial number who are unaware of their status. With recent findings demonstrating the high transmissibility of HIV early in infection, and the potential benefit of early initiation of treatment, it is essential to identify as many infected individuals as possible. The Centers for Disease Control and Prevention (CDC) has expanded HIV testing to include any healthcare setting, including dental offices. Testing advances, including oral testing, have reduced the window period of HIV infection. Dental care represents a key, reliable, independent, and confidential link between the healthcare system and the general population that has been under-utilized in the effort to control the HIV epidemic. HIV testing is straightforward, and knowledge of the types of testing will afford dentists an important opportunity to help advance and preserve the health of their patients and to promote the public health of their community. Here, we review the basics of HIV testing and discuss new changes in the approach to HIV diagnostics.
    Oral Diseases 11/2012; 19(5). DOI:10.1111/odi.12047 · 2.43 Impact Factor
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    ABSTRACT: : The value of HIV testing has grown in parallel with the development of increasingly effective HIV treatment. Evidence for the substantial reductions in transmission when persons receive antiretroviral therapy creates a new impetus to increase testing and early diagnosis. Models of treatment as prevention-dubbed "test and treat"-give reason for optimism that control and elimination of HIV may now be within reach. This will be possible only with widespread testing, prompt and accurate diagnosis, and universal access to immediate antiviral therapy. Many successful approaches for scaling up testing were pioneered in resource-limited countries before they were adopted by countries in the developed world. The future of HIV testing is changing. Lessons learned from other case-finding initiatives can help chart the course for comparable HIV testing endeavors.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 07/2013; 63 Suppl 2(Suppl 2):S117-21. DOI:10.1097/QAI.0b013e3182986f25 · 4.56 Impact Factor
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