Fewer than 1 in 5 emergency departments implement recommendations for HIV screening
Fewer than 20 percent of emergency departments (EDs) perform recommended routine screening of certain populations for HIV infection, according to a new study. This is a problem, since an estimated 21 percent of persons with HIV infection are undiagnosed, especially members of racial and ethnic minorities, the socioeconomically disadvantaged, and the uninsured—many of whom use EDs as their main source of primary care. The Centers for Disease Control and Prevention (CDC) issued recommendations in 2006 that called for routine (nontargeted) rapid HIV screening, with opt-out provisions, for populations whose undiagnosed HIV infection prevalence was at least 0.1 percent.
The researchers surveyed a national sample of EDs to examine their familiarity with the CDC recommendations and practices regarding HIV screening of patients. Of the 99 academic and 150 community EDs that responded, a larger proportion of the academic EDs (64 percent) than community EDs (40 percent) reported being familiar with the 2006 CDC recommendations. Yet only 26 percent of academic EDs and 37 percent of community EDs
reported having implemented any part of the recommendations.
Belief that HIV testing was necessary was held by a larger proportion of academic EDs (42 percent) than community EDs (25 percent), but a larger proportion of both groups (65 percent and 50 percent, respectively) actually provided HIV testing. Most performed the tests for diagnostic testing, dropping by half for EDs conducting targeted screening, and falling to 16 percent of academic EDs and 6 percent of community EDs conducting any nontargeted screening. Academic EDs comprise only 3 percent of EDs in the United States. Based on their findings, the researchers recommend increased efforts to improve the ability of community EDs to perform HIV testing. The study was funded in part by the Agency for Healthcare Research and Quality (HS17526).
More details are in "HIV testing in emergency departments in the United States: A national survey," by Jason S. Haukoos, M.D., M.Sc., Emily Hopkins, M.S.P.H., Amber Hull, B.A., and others in the July 2011 Annals of Emergency Medicine 58(1), pp. S10-S16.
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