Research Shows Extremely Low HIV Testing Performed at EDs in 2018

HIV testing occurred in only a small percentage of US emergency department (ED) visits in 2018, according to a study published in JAIDS Journal of Acquired Immune Deficiency Syndromes.

Researchers found that of 83 million weighted visits by patients aged 13 to 64 years without known HIV infection, testing was performed during just 1.05% of visits. These findings were based on 13,237 National Hospital Ambulatory Medical Care Survey (NHAMCS) sample visits.

As the authors contextualized, EDs are an important safety net for patients who are medically underserved and cannot access other forms of health care

“Further, EDs serve populations disproportionately impacted by HIV, regularly treat patients presenting with viral syndrome symptoms, and routinely collect blood as a part of patient care,” they wrote. “Despite previous work by our group demonstrating that 24% of patients presenting to a subset of US EDs reported having never been tested for HIV (23% of whom reported engaging in recent, ongoing, HIV risk-taking behaviors), only a minority of EDs offer routine HIV testing.”

To better understand more recent HIV testing rates across EDs and how these rates differ in areas and populations disproportionately impacted by HIV, the authors stratified NHAMCS data by race, ethnicity, and region.

For the sample population, the median (IQR) age was 37 (25-50) years and most (57.6%) visits were made by female patients. The authors also noted that, of the ED visits, 29% were made by Black patients, 15.1% were made by Hispanic or Latino patients, and 38.4% were made by patients insured by Medicaid. Most (50.7%) visits included a blood draw as part of care.

There was also a notable difference between the percentages of ED visits based on region, with 41.7% of ED visits occurring in the South vs 86.7% of visits in a metropolitan statistical area (MSA). Additionally, HIV testing rates were highest in the Northeast and lowest in the West.

In addition, data showed that HIV testing at EDs was more frequent among younger patients, with patients aged 13 to 34 years receiving testing in 1.32% of total weighted visits vs patients aged 35 to 64 years receiving testing in 0.82% of weighted visits.

Black (1.73%) patients were also more likely to receive testing compared with White (0.79%) or “Other” (0.41%) patients. Further, Hispanic or Latino (2.18%) patients were much more likely to receive testing than non-Hispanic or Latino (0.84%) patients.

Insurance also played a role in HIV testing rates, as patients with Medicaid were more likely to receive testing than patients with private or other insurance.

Regarding the type of ED visit, targeted visits and visits with a documented blood draw included HIV testing more than nontargeted visits and visits with no documented blood draw. However, targeted ED visits with HIV testing still made up less than 3.0% of all weighted ED visits.

“Collectively, our results confirm the idea of ‘missed opportunities’ for HIV testing in US EDs—overall by patient race, ethnicity, and corresponding location,” the authors wrote. “This is notably so given that visits with blood draws and those categorized as targeted (sexually transmitted infections, pregnancy, or sexual abuse-related visits) had relatively low rates of HIV testing.”

Going forward, the authors suggested increasing the amount of opt-out HIV screenings or creating targeted approaches that could flag at-risk individuals.

“In the absence of any significant change, we expect additional missed opportunities for HIV testing and a persistence of undiagnosed HIV among ED patients,” the authors concluded. “Innovative strategies such as social media–based HIV testing are underway, but offering routine HIV testing in the ‘safety net’ of our health system—the ED—remains essential to progress toward HIV elimination.”

Reference

Clay CE, Ling A, Bennett CL. HIV testing at visits to United States emergency departments, 2018. J Acquir Immune Defic Syndr. Published online February 28, 2022. doi:10.1097/QAI.0000000000002945