A very low number of HIV cases are identified in emergency departments via non-targeted testing, researchers from the Emergency Department HIV-Screening Group, France, reported in Archives of Internal Medicine. Non-targeted testing for HIV is actively encouraged in the USA and UK.

As background information, the authors wrote:

“During the last 15 years, human immunodeficiency virus (HIV) screening combined with early treatment has effectively reduced HIV-related mortality, and some authors have postulated that this strategy plays a key role in controlling the epidemic.”

Despite HIV testing in France being free, late diagnosis continues being a persistent problem.

The researchers added:

“To lower the number of undiagnosed infections and to improve early detection, nontargeted HIV rapid test (RT) screening in health care settings has been promoted by national health agencies in the United States, the United Kingdom, and, more recently, France. In France, because an estimated 25 percent of inhabitants (14 million) visit an ED [emergency department] annually, EDs appear to be an ideal setting to assess nontargeted HIV-RT screening of the general population.

Kayigan Wilson d’Almeida, M.D., and team carried out an interventional study in 29 emergency departments in France from May 2009 to the end of September 2010. They EDs were randomly assigned. Each emergency department was monitored for six consecutive weeks.

Patients aged from 18 to 64 years were offered HIV testing using a fingerstick whole-blood HIV RT.

The authors wrote:

“Main outcome measures were the number of patients tested for HIV and their characteristics vs those of the general metropolitan Paris population and the proportion of newly diagnosed HIV-positive patients among those tested and their characteristics vs those from the national HIV case surveillance.”

Below are some highlighted data from their study:

  • There were 138, 691 visits
  • 78,411 patients were eligible for HIV RT
  • 20,962 (27%) were offered HIV RT
  • 13,229 or 63.1% of them agreed to have the test
  • 16.3% or 12,754 out of all the ED visitors were tested
  • 0.14% of the patients received a new HIV diagnosis – just 18 people

The authors wrote:

“The ED patients’ characteristics reflected the
general population distribution.”

The average age of newly diagnosed patients was 32.9 years – twelve of them (66.7%) had been tested previously, seven of them (39%) said they had had sex with men, and 10 (55%) were heterosexuals from sub-Saharan Africa.

The researchers concluded:

“ED-based HIV RT screening is feasible and can reach large numbers of patients. However, unexpectedly, nontargeted screening identified only a few new diagnoses, often already at late stages, and most newly diagnosed patients belonged to a high-risk group and had been tested previously. Therefore, our observations do not support the implementation of nontargeted HIV screening of the general population in Eds.”

Jason S. Haukoos, M.D., M.Sc., from Denver Health Medical Center, Denver, Colo., in an Accompanying Commentary, wrote:

“Early identification of human immunodeficiency (HIV) infection remains a critical public health priority. In the United States, approximately 240,000 individuals remain undiagnosed and 56,000 new infections occur annually.”

According to Dr. Haukoos, the CDC (Centers for Disease Control and Prevention) recommends “routine’ (nontargeted) opt-out HIV screening in healthcare settings, including emergency departments (EDs) because EDs are considered the most common site of missed opportunities for diagnosing HIV infection.”

Dr. Haukoos added:

“Rigorous, large-scale, comparative effectiveness research is needed to understand how best to identify patients with undiagnosed HIV infection. In the end, the use of targeted HIV screening strategies may still help prioritize HIV testing and prevention resources where the epidemic is concentrated.”

Written by Christian Nordqvist