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Routine HIV Screening in the Emergency Department Using the New US Centers for Disease Control and Prevention Guidelines: Results From a High-Prevalence Area

Brown, Jeremy MD*; Shesser, Robert*; Simon, Gary MD†; Bahn, Maria*; Czarnogorski, Maggie MD†; Kuo, Irene PhD‡; Magnus, Manya PhD‡; Sikka, Neal MD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 December 2007 - Volume 46 - Issue 4 - pp 395-401
doi: 10.1097/QAI.0b013e3181582d82
Clinical Science

Background: In 2006, the US Centers for Disease Control and Prevention (CDC) released new recommendations for routine HIV testing. Among these were recommendations that emergency departments (EDs) offer routine opt-out HIV screening to their patients. We established a screening program implementing these recommendations at an urban university hospital ED in Washington, DC. We report the results of this program.

Methods: During a 3-month period, ED patients being treated for a wide range of conditions were approached by trained HIV screeners and offered point-of-care rapid HIV testing. Patients with positive results were referred to hospital or community resources for confirmatory testing and treatment.

Results: During the program period, 14,986 patients were treated in the ED and 4151 (27.6%) were offered HIV screening. The mean patient age was 37.5 years; 48.5% were black, 39.0% were non-Hispanic white, 4.1% were Hispanic, 1.7% were Asian, and 6.7% responded as being other race. A total of 56.1% were female, and most lived within the Washington, DC metropolitan area. Of the patients offered HIV screening, 2476 (59.7%) accepted the test. Of the 26 patients with a preliminary positive screen, 13 were lost to follow-up, 9 were confirmed positive by Western blot, and 4 were confirmed negative by Western blot. Eight of the 9 patients with confirmed HIV infection were successfully linked to follow-up care.

Conclusions: The implementation of the CDC recommendations establishing routine opt-out HIV screening programs in EDs is feasible. Further efforts to establish routine ED HIV testing are therefore warranted.

From the *Department of Emergency Medicine, The George Washington University Medical Center, Washington, DC; †Division of Infectious Diseases, Department of Medicine, The George Washington University Medical Center, Washington, DC; and the ‡Department of Epidemiology and Biostatistics, The George Washington University HIV/AIDS Institute, The George Washington University Medical Center, Washington, DC.

Received for publication April 22, 2007; accepted August 13, 2007.

Supported by the Department of Health, District of Columbia, and an unrestricted grant from Gilead Sciences.

Jeremy Brown had full access to all the data in the program and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Correspondence to: Jeremy Brown, MD, Department of Emergency Medicine, The George Washington University Medical Center, Medical Faculty Associates, 2150 Pennsylvania Avenue NW, Washington, DC 20037 (e-mail: jbrown@mfa.gwu.edu).

© 2007 Lippincott Williams & Wilkins, Inc.