An expanded HIV screening strategy in the Emergency Department fails to identify most patients with undiagnosed infection

insights from a blinded serosurvey

Uriel R. Felsen, Lucia V. Torian, Donna C. Futterman, Stephen Stafford, Qiang Xia, David Allan, David Esses, Chinazo O. Cunningham, Jeffrey M. Weiss, Barry S. Zingman

Research output: Contribution to journalArticle

Abstract

Screening for HIV in Emergency Departments (EDs) is recommended to address the problem of undiagnosed HIV. Serosurveys are an important method for estimating the prevalence of undiagnosed HIV and can provide insight into the effectiveness of an HIV screening strategy. We performed a blinded serosurvey in an ED offering non-targeted HIV screening to determine the proportion of patients with undiagnosed HIV who were diagnosed during their visit. The study was conducted in a high-volume, urban ED and included patients who had blood drawn for clinical purposes and had sufficient remnant specimen to undergo deidentified HIV testing. Among 4752 patients not previously diagnosed with HIV, 1403 (29.5%) were offered HIV screening and 543 (38.7% of those offered) consented. Overall, undiagnosed HIV was present in 12 patients (0.25%): six among those offered screening (0.4%), and six among those not offered screening (0.2%). Among those with undiagnosed HIV, two (16.7%) consented to screening and were diagnosed during their visit. Despite efforts to increase HIV screening, more than 80% of patients with undiagnosed HIV were not tested during their ED visit. Although half of those with undiagnosed HIV were missed because they were not offered screening, the yield was further diminished because a substantial proportion of patients declined screening. To avoid missed opportunities for diagnosis in the ED, strategies to further improve implementation of HIV screening and optimize rates of consent are needed.

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Hospital Emergency Service
HIV
Infection

Keywords

  • Emergency Department
  • HIV screening
  • serosurvey
  • undiagnosed HIV

ASJC Scopus subject areas

  • Health(social science)
  • Social Psychology
  • Public Health, Environmental and Occupational Health

Cite this

@article{bcbf449c4a004e558768d3d2ed1b15f6,
title = "An expanded HIV screening strategy in the Emergency Department fails to identify most patients with undiagnosed infection: insights from a blinded serosurvey",
abstract = "Screening for HIV in Emergency Departments (EDs) is recommended to address the problem of undiagnosed HIV. Serosurveys are an important method for estimating the prevalence of undiagnosed HIV and can provide insight into the effectiveness of an HIV screening strategy. We performed a blinded serosurvey in an ED offering non-targeted HIV screening to determine the proportion of patients with undiagnosed HIV who were diagnosed during their visit. The study was conducted in a high-volume, urban ED and included patients who had blood drawn for clinical purposes and had sufficient remnant specimen to undergo deidentified HIV testing. Among 4752 patients not previously diagnosed with HIV, 1403 (29.5{\%}) were offered HIV screening and 543 (38.7{\%} of those offered) consented. Overall, undiagnosed HIV was present in 12 patients (0.25{\%}): six among those offered screening (0.4{\%}), and six among those not offered screening (0.2{\%}). Among those with undiagnosed HIV, two (16.7{\%}) consented to screening and were diagnosed during their visit. Despite efforts to increase HIV screening, more than 80{\%} of patients with undiagnosed HIV were not tested during their ED visit. Although half of those with undiagnosed HIV were missed because they were not offered screening, the yield was further diminished because a substantial proportion of patients declined screening. To avoid missed opportunities for diagnosis in the ED, strategies to further improve implementation of HIV screening and optimize rates of consent are needed.",
keywords = "Emergency Department, HIV screening, serosurvey, undiagnosed HIV",
author = "Felsen, {Uriel R.} and Torian, {Lucia V.} and Futterman, {Donna C.} and Stephen Stafford and Qiang Xia and David Allan and David Esses and Cunningham, {Chinazo O.} and Weiss, {Jeffrey M.} and Zingman, {Barry S.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1080/09540121.2019.1619663",
language = "English (US)",
journal = "AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV",
issn = "0954-0121",
publisher = "Routledge",

}

TY - JOUR

T1 - An expanded HIV screening strategy in the Emergency Department fails to identify most patients with undiagnosed infection

T2 - insights from a blinded serosurvey

AU - Felsen, Uriel R.

AU - Torian, Lucia V.

AU - Futterman, Donna C.

AU - Stafford, Stephen

AU - Xia, Qiang

AU - Allan, David

AU - Esses, David

AU - Cunningham, Chinazo O.

AU - Weiss, Jeffrey M.

AU - Zingman, Barry S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Screening for HIV in Emergency Departments (EDs) is recommended to address the problem of undiagnosed HIV. Serosurveys are an important method for estimating the prevalence of undiagnosed HIV and can provide insight into the effectiveness of an HIV screening strategy. We performed a blinded serosurvey in an ED offering non-targeted HIV screening to determine the proportion of patients with undiagnosed HIV who were diagnosed during their visit. The study was conducted in a high-volume, urban ED and included patients who had blood drawn for clinical purposes and had sufficient remnant specimen to undergo deidentified HIV testing. Among 4752 patients not previously diagnosed with HIV, 1403 (29.5%) were offered HIV screening and 543 (38.7% of those offered) consented. Overall, undiagnosed HIV was present in 12 patients (0.25%): six among those offered screening (0.4%), and six among those not offered screening (0.2%). Among those with undiagnosed HIV, two (16.7%) consented to screening and were diagnosed during their visit. Despite efforts to increase HIV screening, more than 80% of patients with undiagnosed HIV were not tested during their ED visit. Although half of those with undiagnosed HIV were missed because they were not offered screening, the yield was further diminished because a substantial proportion of patients declined screening. To avoid missed opportunities for diagnosis in the ED, strategies to further improve implementation of HIV screening and optimize rates of consent are needed.

AB - Screening for HIV in Emergency Departments (EDs) is recommended to address the problem of undiagnosed HIV. Serosurveys are an important method for estimating the prevalence of undiagnosed HIV and can provide insight into the effectiveness of an HIV screening strategy. We performed a blinded serosurvey in an ED offering non-targeted HIV screening to determine the proportion of patients with undiagnosed HIV who were diagnosed during their visit. The study was conducted in a high-volume, urban ED and included patients who had blood drawn for clinical purposes and had sufficient remnant specimen to undergo deidentified HIV testing. Among 4752 patients not previously diagnosed with HIV, 1403 (29.5%) were offered HIV screening and 543 (38.7% of those offered) consented. Overall, undiagnosed HIV was present in 12 patients (0.25%): six among those offered screening (0.4%), and six among those not offered screening (0.2%). Among those with undiagnosed HIV, two (16.7%) consented to screening and were diagnosed during their visit. Despite efforts to increase HIV screening, more than 80% of patients with undiagnosed HIV were not tested during their ED visit. Although half of those with undiagnosed HIV were missed because they were not offered screening, the yield was further diminished because a substantial proportion of patients declined screening. To avoid missed opportunities for diagnosis in the ED, strategies to further improve implementation of HIV screening and optimize rates of consent are needed.

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KW - HIV screening

KW - serosurvey

KW - undiagnosed HIV

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DO - 10.1080/09540121.2019.1619663

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