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

National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 05/2007; 44(4):435-42. DOI: 10.1097/QAI.0b013e31802f83d0
Source: PubMed


To evaluate and compare HIV screening and provider-referred diagnostic testing as strategies for detecting undiagnosed HIV infection in an urban emergency department (ED).
From January 2003 through April 2004, study staff offered HIV screening with rapid tests to ED patients regardless of risks or symptoms. ED providers could also refer patients for diagnostic testing. Patients aged 18 to 54 years without known HIV infection were eligible.
Of 4849 eligible patients approached for screening, 2824 (58%) accepted and were tested; 414 (95%) of 436 provider-referred patients accepted and were tested. Thirty-five (1.2%) screened patients and 48 (11.6%) provider-referred patients were infected with HIV (P < 0.001). Of these, 18 (51%) screened patients and 24 (50%) referred patients reported no traditional risk factors; 27 (77%) screened patients and 38 (79%) referred patients entered HIV care. Of HIV-infected patients with CD4 cell counts available, 14 (45%) of 31 screened patients and 37 (82%) of 45 provider-referred patients had <200 cells/microL (P < 0.001).
ED screening detects HIV infection and links to care patients who may not be tested through risk- or symptom-based strategies. The diagnostic yield was higher among provider-referred patients, but screening detected patients earlier in the course of disease.

Download full-text


Available from: Bernard Branson
  • Source
    • "Given the shortage of resources in the ED and the compelling evidence that the ED serves an increasingly important role in mitigating the HIV epidemic [6, 12], it is important to resolve how best to integrate routine HIV screening in the already congested ED environment [13]. Limited research has been performed to understand how the contextual factors can improve the implementation of HIV testing programs in the ED [12, 14–16]. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Sep 2014
  • Source
    • "programs. Using all studies included in the base case and sensitivity analyses, the probability that a patient was offered testing was 11 times as high in the studies that used existing staff (48% compared with 4%) and the overall probability that an ED patient would be tested was over four times as high for the studies that used existing staff (12.4%) (CDC, 2007; del Rio et al., 2001) compared with those that used supplemental staff (3.1%) (CDC, 2007; Lyss et al., 2007; Silva et al., 2007). Despite the fact that twice as many patients who accepted testing were actually tested under the supplemental model (98%), compared with the existing model (39%, base case values), we found that increasing the probabilities of offering, accepting, and testing to 100% for the supplemental staff would still not change the results to favor the supplemental model. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although previous studies have shown that HIV screening in emergency departments (EDs) is feasible, the costs and outcomes of alternative methods of implementing ED screening have not been examined. We compared the costs and outcomes of a model that used the hospital's ED staff to conduct screening, a supplemental staff model that used non-ED staff hired to conduct screening and a hypothetical hybrid model that combined aspects of both approaches. We developed a decision analytic model to estimate the cost per HIV-infected patient identified using alternative ED testing models. The cost per new HIV infection identified was $3,319, $2,084 and $1,850 under the supplemental, existing staff and hybrid models, respectively. Assuming an annual ED census of 50,000 patients, the existing staff model identified 29 more HIV infections than the supplemental model and the hybrid model identified 76 more infections than the existing staff model. Our findings suggest that a hybrid model should be favored over either a supplemental staff or existing staff model in terms of cost per outcome achieved.
    Full-text · Article · Jun 2011 · AIDS education and prevention: official publication of the International Society for AIDS Education
  • Source
    • "Downloaded By: [Kominski, Gerald F.][University of California, Los Angeles] At: 01:27 26 January 2011 large portion of ED patients are willing to be screened for HIV (Brown et al., 2007; Haukoos, Hopkins, & Byyny, 2008; Lyss et al., 2007). One of the studies also shows that HIV infection was newly detected in 1.2% screened patients and 11.6% provider-referred patients in an urban emergency department (Lyss et al., 2007). Although this coverage mandate opens the door for routine HIV testing, the actual impact on HIV testing rates could be minimal for several reasons. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To increase HIV testing, in 2008 California's governor signed the first piece of legislation in the USA to require private health plans to cover the cost of HIV testing regardless of whether testing is related to a primary diagnosis. This study assesses the impacts of the bill on coverage, testing rate, and cost for 22,190,000 Californians. All targeted individuals had some form of coverage for HIV testing before the mandate. If minimum expansion of coverage occurs, overall expenditures on HIV testing are projected to increase by US$554,000 in the year following the adoption of the law. If testing broadens to comply with the Centers for Disease Control and Prevention (CDC) testing guidelines, annual expenditures are projected to increase by US$10,151,000. This policy change could serve as a step toward making HIV testing a routine screening test. However, the impact of this mandate largely depends on people's awareness and willingness to adopt the CDC guidelines.
    Full-text · Article · Feb 2011 · AIDS Care
Show more