Universal HIV Testing in EDs Yields New Diagnoses, Linkage to Care in San Diego Hospitals

While targeted testing for HIV has helped more individuals to be diagnosed and treated, the CDC recommends routine, universal HIV screening for all individuals aged 13 years to 64 years as a way to reach populations who may be less likely to seek out or participate in HIV testing. Emergency departments (EDs) in particular may play an important role in universal screening, as evidenced by the experience of 2 academic EDs in San Diego, California.

Writing in Science Reports, researchers from the University of California San Diego said that a universal screening program was not only able to yield new diagnoses of HIV and link patients with care, but that universal screening can also help to relink patients who already know their HIV-positive status but who are out of care.

Between 2017 and 2018, wrote the researchers, 28,708 patients aged 13 to 64 visited the 2 EDs, and 73% of them answered either “no” or “unknown” when asked if they had been tested for HIV. Of that group, 72.00% did not opt out of HIV testing, and, ultimately, 83.00% of those who did not opt out had an HIV test result.

In total, 0.64% of patients tested had a confirmed positive result. Of these patients, there were 10 patients with false positive results upon retesting, 38 patients who had previously tested positive after review, and 33 patients who had a new HIV diagnosis. Of the patients with a new diagnosis, 30 (90.00%) were successfully linked to care, a result largely attributable to dedicate case management, prompt notification of test results, and post-test counseling.

Additionally, 74 individuals who had known HIV-positive status but who were out of care for more than 12 months were identified. Among this group, 50 patients were successfully relinked to care.

Notably, the researchers say that HIV testing increased once opt-out discussions were moved from nursing triage in the ED to a bedside discussion at the time of the blood draw; opt-out rates fell from 37.00% to just 5.00%.

The low rate of new HIV diagnoses, write the authors, may be due to the fact that San Diego has multiple, free, community-based HIV screening programs that have been available since 1996. The largest of these programs provides approximately 4000 tests per year, and the program has been shown in previous research to have been linked with a decrease in new HIV diagnoses in the area. Use of pre-exposure prophylaxis in high-risk individuals may also be playing a role in the relatively low rate of new HIV diagnoses.

“Importantly, our program still yielded 33 new HIV diagnoses of which 90% were successfully linked to care, highlighting the importance of ED HIV screening in further tackling the HIV epidemic in San Diego,” wrote the authors.

They also note that the demographics of the newly diagnosed patients differed slightly from those reported across the County of San Diego, with higher proportion of new diagnoses among African Americans compared with the county average, and with a higher proportion of new diagnoses among women, African Americans, and those indicating heterosexual contact as a main risk factor compared with community-based HIV screening programs, suggesting that EDs can reach patients who may be less likely to be tested elsewhere.

Reference

Hoenigl M, Mathur K, Blumenthal J, et al. Universal HIV and birth cohort HCV screening in San Diego Emergency Departments. Sci Rep. 2019;9:14479. doi: 10.1038/s41598-019-51128-6.