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February 19, 1999

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HIV Testing In Emergency Departments Yields Early Detection of Cases

A voluntary, emergency department-based program to test patients' blood for HIV was well accepted at Johns Hopkins, as about half the patients approached consented.

"For many people at high risk of HIV infection, the emergency department (ED) remains their only ready access to the health care system and their only opportunity for HIV counseling and testing," says lead author Gabor D. Kelen, M.D., professor and chair of emergency medicine. "Because most ED patients are not admitted, the opportunity to identify HIV early may be missed unless voluntary screening is done. This could vastly improve our HIV early detection rates."

Kelen says during a pilot program at Hopkins, nearly 50 percent of patients agreed to be tested. After counseling, nearly two-thirds of newly diagnosed patients made it to follow-up appointments with a health clinic. "We may have prevented a significant number of further transmissions," he says.

Study results were published in the February issue of the Annals of Emergency Medicine.

The study was split into three phases between 1993 and 1995. During the first phase, researchers assessed people's general receptiveness to an on-site ED screening program for HIV. During the second phase, some patients had the option of choosing either a standard HIV test or a rapid test that would provide results within an hour. During the third, the rapid test was offered to all patients.

Overall, 3,048 patients ages 18 to 55 who were mentally competent and not known to already have HIV were approached about HIV testing. Of those, 1,448 (48 percent) consented, 981 to standard testing and 467 to rapid testing.

About 6.4 percent of those who had standard testing and 3.2 percent of those who had rapid testing were newly identified as being HIV positive. More than twice as many new infections were diagnosed among those discharged from the ED as those admitted. Even among those previously tested, 5 percent tested positive. Patients testing positive were counseled and helped to schedule follow-up appointments at local health clinics.

"HIV testing detected a significant number of new infections earlier than might otherwise have been, particularly among patients sent home," Kelen says.

The highest rates of positive HIV tests were among males (7.6 percent), blacks (5.5 percent), those ages 35 to 46 (8.6 percent), those who engaged in intravenous drug use (17 percent), those who were admitted to the hospital (10.2 percent) and those without insurance (7.6 percent).

The study also found that:
* Gender did not appear to play a role in the likelihood of consent, although ethnic background did. Nearly half of blacks approached agreed to testing, while only 35 percent of whites did.
* Fifty-seven percent of patients with established sex-related or intravenous drug use risks participated, compared to 44 percent of those in whom no risks were established.
* Forty-two percent of patients who have private physicians participated, compared to 52 percent who generally come to the emergency department for medical care.
* Of those who declined testing, 43 percent said they already had been tested, 24 percent denied being at risk and 13 percent said they were uninterested.

Costs for the program were comparable to those at other health clinics.

The study's other authors were Judy B. Shahan, R.N., and Thomas C. Quinn, M.D.


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