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Silva A, Glick NR, Lyss SB, Hutchinson AB, Gift TL, Pealer LN, et al. Implementing an HIV and sexually transmitted disease screening program in an emergency department

Sinai Urban Health Institute, Sinai Health System, Mount Sinai Hospital, Chicago, IL 60608, USA.
Annals of emergency medicine (Impact Factor: 4.33). 06/2007; 49(5):564-72. DOI: 10.1016/j.annemergmed.2006.09.028
Source: PubMed

ABSTRACT We assess the feasibility, effectiveness, and cost of routinely recommended HIV/sexually transmitted disease screening in an urban emergency department (ED).
From April 2003 to August 2004, patients aged 15 to 54 years were offered rapid HIV testing, and those aged 15 to 25 years were also offered gonorrhea and chlamydia testing (nucleic acid amplification), Monday through Friday, 11 am to 8 pm. Infected patients were referred for treatment and care. Prevalence, treatment rates, and cost were assessed.
Among 3,030 patients offered HIV testing, 1,447 (47.8%) accepted, 8 (0.6%) tested positive, and 3 (37.5%) were linked to care. Among 791 patients offered sexually transmitted disease testing, 386 (48.8%) accepted, 320 provided urine (82.9%), 48 (15.0%) tested positive, and 42 (87.5%) were treated for gonorrhea or chlamydia. The program cost was $72,928. Costs per HIV-infected patient identified and linked to care were, respectively, $9,116 and $24,309; cost per sexually transmitted disease-infected patient treated was $1,736. The program cost for HIV/sexually transmitted disease screening was only $14,340 more than if we screened only for HIV.
Through ED-based HIV/sexually transmitted disease screening, we identified and treated many sexually transmitted disease-infected patients but identified few HIV-infected patients and linked even fewer to care. However, sexually transmitted disease screening can be added to HIV screening at a reasonable cost.

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    • "The Centers for Disease Control and Prevention (CDC) and emergency medicine clinicians are advocating for expanded HIV diagnostic testing and HIV screening in US emergency departments (EDs) (Babcock Irvin, Wyer, & Gerson, 2000; Branson et al., 2006; Rhodes, Gordon, & Lowe, 2000; Rothman, Ketlogetswe, Dolan, Wyer, & Kelen, 2003). The rationale for this measure is based on the observations that some US EDs provide medical care to large numbers of patients who are at higher risk of HIV infection (Alpert, Shuter, DeShaw, Webber, & Klein, 1996; Glick, Silva, Zun, & Whitman, 2004; Goggin, Davidson, Cantril, O'Keefe, & Douglas, 2000; Kelen et al., 1996; Kelen, Shahan, & Quinn, 1999; Lyons, Lindsell, Ledyard, Frame, & Trott, 2005a; Mehta et al., 2007), some US EDs have a high prevalence of patients known to be HIV infected (Alpert et al., 1996; Goggin et al., 2000; Kelen et al., 1995; Nagachinta, Gold, Cheng, Heseltine, & Kerndt, 1996; Sloan et al., 1995), and several ED-based HIV screening studies have successfully identified patients with a previously undiagnosed HIV infection (Centers for Disease Control and Prevention, 2007; Glick et al., 2004; Goggin et al., 2000; Kelen et al., 1999; Lyons et al., 2005a,b; Lyss et al., 2007; Mehta et al., 2007; Silva et al., 2007). "
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    ABSTRACT: The aim of this investigation was to assess emergency department (ED) patients' perceptions and preferences about an opt-in, universal, rapid HIV screening program and identify patient groups who expressed stronger beliefs about components of the testing program. From July 2005 to July 2006, ED patients in the opt-in, universal, rapid HIV screening program were interviewed in person. Multivariable regression models were used to compare participants on their beliefs about the program components. Of the 561 participants, 62.0% had previously been tested for HIV. The majority of participants (58.8%) believed the rapid and standard/conventional HIV tests to be equally accurate, 27.7% believed the rapid test to be less or much less accurate, and 8.7% believed the rapid test to be more or much more accurate. Almost two-thirds (65.1%) favored having a rapid instead of a standard/conventional HIV test, 94.6% wanted the test results within one hour, and 61.3% would be likely or very likely to undergo testing in the ED if it prolonged their ED visit. Almost all (92.5%) believed that their medical care was "not at all" delayed because of being tested, 94.1% believed that testing did "not at all" divert attention from the reason for their ED visit, and 80.9% thought that testing in the ED was "not at all" stressful. In multivariable logistic regression models, males and those with more than 12 years of formal education showed greater concerns about the rapid HIV test's accuracy. Hispanic/Latinos, participants with governmental insurance, and those previously HIV tested were more apt to be screened for HIV even if testing delayed their ED departure. Overall, participants were highly accepting of the components of this opt-in rapid HIV screening program. However, concerns regarding the accuracy of the rapid HIV test might limit test acceptance and should be addressed during pre-test information procedures.
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