National estimation of rates of HIV serology testing in US emergency departments 1993-2005: Baseline prior to the 2006 Centers for Disease Control and Prevention recommendations

Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA.
AIDS (London, England) (Impact Factor: 5.55). 11/2008; 22(16):2127-34. DOI: 10.1097/QAD.0b013e328310e066
Source: PubMed


The 2006 Centers for Disease Control and Prevention recommendations place increased emphasis on emergency departments (EDs) as one of the most important medical care settings for implementing routine HIV testing. No longitudinal estimates exist regarding national rates of HIV testing in EDs. We analyzed a nationally representative ED database to assess HIV testing rates and characterize patients who received HIV testing, prior to the release of the 2006 guidelines.
A cross-sectional analysis of US ED visits (1993-2005) using the National Hospital Ambulatory Medical Care Survey was performed.
Patients aged 13-64 years were included for analysis. Diagnoses were grouped with Healthcare Cost and Utilization Project Clinical Classifications Software. Analyses were performed using procedures for multiple-stage survey data.
HIV testing was performed in an estimated 2.8 million ED visits (95% confidence interval, 2.4-3.2) or a rate of 3.2 per 1000 ED visits (95% confidence interval, 2.8-3.7). Patients aged 20-39 years, African-American, and Hispanic had the highest testing rates. Among those tested, leading reasons for visit were abdominal pain (9%), puncture wound/needlestick (8%), rape victim (6%), and fever (5%). The leading medication class prescribed was antimicrobials (32%). The leading ED diagnosis was injury/poisoning (30%) followed by infectious diseases (18%). Of note, 6% of those tested were diagnosed with HIV infection during their ED visits.
Prior to the release of the 2006 Centers for Disease Control and Prevention guidelines for routine HIV testing in all healthcare settings, baseline national HIV testing rates in EDs were extremely low and appeared to be driven by clinical presentation.

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    • "While the ED remains overcrowded, the integration of routine HIV testing into this oftentimes chaotic environment becomes challenging. Therefore it is not surprising that, prior to the 2006 CDC recommendation for routine HIV screening, the rate of HIV testing in US EDs was found to be only 0.3% [26]. These low testing rates in the ED are consistent across studies, even at patient visits with a blood draw when an HIV test can be easily performed. "
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    ABSTRACT: Study Objectives. In response to the 2010 New York State HIV testing law, we sought to understand the contextual factors that influence HIV testing rates in the emergency department (ED). Methods. We analyzed electronic health record logs from 97,655 patients seen in three EDs in New York City. We used logistic regression to assess whether time of day, day of the week, and season significantly affected HIV testing rates. Results. During our study period, 97,655 patients were evaluated and offered an HIV test. Of these, 7,763 (7.9%) agreed to be tested. Patients arriving between 6 a.m. and 7:59 p.m. were significantly (P < 0.001) more likely to be tested for HIV, followed by patients arriving between 8:00 p.m. and 9:59 p.m. (P < 0.01) and followed by patients arriving between 5-5:59 a.m. and 10-10:59 p.m. (P < 0.05) compared to patients arriving at midnight. Seasonal variation was also observed, where patients seen in July, August, and September (P < 0.001) were more likely to agree to be tested for HIV compared to patients seen in January, while patients seen in April and May (P < 0.001) were less likely to agree to be tested for HIV. Conclusion. Time of day and season affect HIV testing rates in the ED, along with other factors such as patient acuity and completion of other blood work during the ED visit. These findings provide useful information for improving the implementation of an HIV testing program in the ED.
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