Skip to main content

Advertisement

SpringerLink
Log in

HIV Testing in the Emergency Department

  • Infectious Disease (J Glauser, Section Editor)
  • Published:
Current Emergency and Hospital Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review explores data from the past 5 years with regard to HIV testing and diagnosis in the emergency department, as well downstream linkage to care and several adjuvant approaches. We offer perspectives on futures directions for care.

Recent Findings

There are many approaches to HIV testing in the ED. The largest overarching question is that of testing strategies (universal vs targeted, opt in vs out), where data is mixed and there is a lack of randomized control trials. Other studies address different aspects of ED testing, including where to integrate testing into ED workflow, and supplementary approaches such as electronic tablets.

Summary

In the USA, the emergency department plays a unique role in healthcare and is positioned to offer significant benefits to HIV testing and diagnosis. There are many ways to improve HIV testing rates, and we await further controlled trials to determine an optimal approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Haverkos HW, Curran JW. The current outbreak of Kaposi’s sarcoma and opportunistic infections. CA Cancer J Clin. 1982;32(6):330–9. https://doi.org/10.3322/canjclin.32.6.330.

    Article  PubMed  CAS  Google Scholar 

  2. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382(9903):1525–33. https://doi.org/10.1016/s0140-6736(13)61809-7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Marcus JL, Chao CR, Leyden WA, Xu L, Quesenberry CP Jr, Klein DB, et al. Narrowing the gap in life expectancy between HIV-infected and HIV-uninfected individuals with access to care. J Acquir Immune Defic Syndr. 2016;73(1):39–46. https://doi.org/10.1097/QAI.0000000000001014.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dailey AF, Hoots BE, Hall HI, Song R, Hayes D, Fulton P Jr, et al. Vital signs: human immunodeficiency virus testing and diagnosis delays - United States. MMWR Morb Mortal Wkly Rep. 2017;66(47):1300–6. https://doi.org/10.15585/mmwr.mm6647e1.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Branson BM, Owen SM, Wesolowski LG, Bennett B, Werner BG, Wroblewski KE, et al. Laboratory testing for the diagnosis of HIV infection: updated recommendations. In: Prevention CfDCa, editor. 2014.

  6. Chou R, Selph S, Dana T, Bougatsos C, Zakher B, Blazina I, et al. Screening for HIV: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. 2012(95).

  7. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. In: Services DoHaH, editor. 2018.

  8. Hurt CB, Nelson JAE, Hightow-Weidman LB, Miller WC. Selecting an HIV test: a narrative review for clinicians and researchers. Sex Transm Dis. 2017;44(12):739–46. https://doi.org/10.1097/OLQ.0000000000000719.

    Article  PubMed  Google Scholar 

  9. Smallwood M, Pant Pai N. Improving the quality of diagnostic studies evaluating point of care tests for acute HIV infections: problems and recommendations. Diagnostics (Basel). 2017;7(1) https://doi.org/10.3390/diagnostics7010013.

  10. Delaney KP, Wesolowski LG, Owen SM. The evolution of HIV testing continues. Sex Transm Dis. 2017;44(12):747–9. https://doi.org/10.1097/OLQ.0000000000000736.

    Article  PubMed  Google Scholar 

  11. Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. U.S. Department of Health and Human Services. 2006. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm. Accessed May 2018.

  12. Physicians ACoE. HIV testing and screening in the emergency department. Policy statement. Ann Emerg Med. 2014;64(5):563. https://doi.org/10.1016/j.annemergmed.2014.08.033.

    Article  Google Scholar 

  13. Haukoos JS, Hopkins E, Bucossi MM. Routine opt-out HIV screening: more evidence in support of alternative approaches? Sex Transm Dis. 2014;41(6):403–6. https://doi.org/10.1097/OLQ.0000000000000139.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Geren KI, Lovecchio F, Knight J, Fromm R, Moore E, Tomlinson C, et al. Identification of acute HIV infection using fourth-generation testing in an opt-out emergency department screening program. Ann Emerg Med. 2014;64(5):537–46. https://doi.org/10.1016/j.annemergmed.2014.05.021.

    Article  PubMed  Google Scholar 

  15. • Montoy JC, Dow WH, Kaplan BC. Patient choice in opt-in, active choice, and opt-out HIV screening: randomized clinical trial. BMJ. 2016;532:h6895. https://doi.org/10.1136/bmj.h6895. First randomized control trial to examine opt-out vs opt-in strategy. Shows an advantage for opt-out screning.

    Article  PubMed  CAS  Google Scholar 

  16. Prekker ME, Gary BM, Patel R, Olives T, Driver B, Dunlop SJ, et al. A comparison of routine, opt-out HIV screening with the expected yield from physician-directed HIV testing in the ED. Am J Emerg Med. 2015;33(4):506–11. https://doi.org/10.1016/j.ajem.2014.12.057.

    Article  PubMed  Google Scholar 

  17. Henriquez-Camacho C, Villafuerte-Gutierrez P, Perez-Molina JA, Losa J, Gotuzzo E, Cheyne N. Opt-out screening strategy for HIV infection among patients attending emergency departments: systematic review and meta-analysis. HIV Med. 2017;18(6):419–29. https://doi.org/10.1111/hiv.12474.

    Article  PubMed  CAS  Google Scholar 

  18. National Center for HIV/AIDS VH, STD, and TB Prevention. Understanding the HIV care continuum. In: CDC, editor. 2017.

  19. Menon AA, Nganga-Good C, Martis M, Wicken C, Lobner K, Rothman RE, et al. Linkage-to-care methods and rates in U.S. emergency department-based HIV testing programs: a systematic literature review brief report. Acad Emerg Med. 2016;23(7):835–42. https://doi.org/10.1111/acem.12987.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Richey LE, Halperin J, Pathmanathan I, Van Sickels N, Seal PS. From diagnosis to engagement in HIV care: assessment and predictors of linkage and retention in care among patients diagnosed by emergency department based testing in an urban public hospital. AIDS Patient Care STDs. 2014;28(6):277–9. https://doi.org/10.1089/apc.2014.0052.

    Article  PubMed  Google Scholar 

  21. Flash CA, Pasalar S, Hemmige V, Davila JA, Hallmark CJ, McNeese M, et al. Benefits of a routine opt-out HIV testing and linkage to care program for previously diagnosed patients in publicly funded emergency departments in Houston, TX. J Acquir Immune Defic Syndr. 2015;69(Suppl 1):S8–15. https://doi.org/10.1097/QAI.0000000000000578.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Dailey A, Hoots B, Hall H, Son R, Hayes D, Fulton P Jr, et al. Morbidity and mortality weekly report. In: CDC, editor. CDC; 2017. p. 1300–6.

  23. Burke RC, Sepkowitz KA, Bernstein KT, Karpati AM, Myers JE, Tsoi BW, et al. Why don’t physicians test for HIV? A review of the US literature. AIDS. 2007;21(12):1617–24. https://doi.org/10.1097/QAD.0b013e32823f91ff.

    Article  PubMed  Google Scholar 

  24. Aronson ID, Guarino H, Bennett AS, Marsch LA, Gwadz M, Cleland CM, et al. Staff perspectives on a tablet-based intervention to increase HIV testing in a high volume, urban emergency department. Front Public Health. 2017;5:170. https://doi.org/10.3389/fpubh.2017.00170.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Elgalib A, Fidler S, Sabapathy K. Hospital-based routine HIV testing in high-income countries: a systematic literature review. HIV Med. 2018;19(3):195–205. https://doi.org/10.1111/hiv.12568.

    Article  PubMed  CAS  Google Scholar 

  26. De Rossi N, Dattner N, Cavassini M, Peters S, Hugli O, Darling KEA. Patient and doctor perspectives on HIV screening in the emergency department: a prospective cross-sectional study. PLoS One. 2017;12(7):e0180389. https://doi.org/10.1371/journal.pone.0180389.

    Article  PubMed  PubMed Central  Google Scholar 

  27. • Downing A, Garcia-Diaz JB. Missed opportunities for HIV diagnosis. J Int Assoc Provid AIDS Care. 2017;16(1):14–7. https://doi.org/10.1177/2325957416661423. Examine barriers to HIV testing in a large hospital system.

    Article  PubMed  Google Scholar 

  28. Rucker MG, Eavou R, Allgood KL, Sinclair D, Lawal R, Tobin A, et al. Implementing routine HIV screening in three Chicago hospitals: lessons learned. Public Health Rep. 2016;131(Suppl 1):121–9. https://doi.org/10.1177/00333549161310S114.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zucker J, Cennimo D, Sugalski G, Swaminathan S. Identifying areas for improvement in the HIV screening process of a high-prevalence emergency department. AIDS Patient Care STDs. 2016;30(6):247–53. https://doi.org/10.1089/apc.2016.0068.

    Article  PubMed  Google Scholar 

  30. Branson BM, Chavez PR, Hanscom B, Greene E, McKinstry L, Buchacz K, et al. Expanding hospital HIV testing in the Bronx, New York and Washington, D.C.: results from the HPTN 065 study. Clin Infect Dis. 2017;66:1581–7. https://doi.org/10.1093/cid/cix1053.

    Article  Google Scholar 

  31. Simon M, McGuire R, Lynch H, Moodey K, Edmonds A, Moore E, et al. The journey toward routinization: triage nursing and the success of an emergency department-based routine HIV testing program. J Emerg Nurs. 2016;42(2):183–5. https://doi.org/10.1016/j.jen.2016.02.003.

    Article  PubMed  Google Scholar 

  32. Galbraith JW, Willig JH, Rodgers JB, Donnelly JP, Westfall AO, Ross-Davis KL, et al. Evolution and escalation of an emergency department routine, opt-out HIV screening and linkage-to-care program. Public Health Rep. 2016;131(Suppl 1):96–106. https://doi.org/10.1177/00333549161310S112.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Merchant RC, Clark MA, Liu T, Rosenberger JG, Romanoff J, Bauermeister J, et al. Preferences for oral fluid rapid HIV self-testing among social media-using young black, Hispanic, and white men-who-have-sex-with-men (YMSM): implications for future interventions. Public Health. 2017;145:7–19. https://doi.org/10.1016/j.puhe.2016.12.002.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Lin J, Baghikar S, Mauntel-Medici C, Heinert S, Patel D. Patient and system factors related to missed opportunities for screening in an electronic medical record-driven, opt-out HIV screening program in the emergency department. Acad Emerg Med. 2017;24(11):1358–68. https://doi.org/10.1111/acem.13277.

    Article  PubMed  Google Scholar 

  35. Schnall R, Liu N, Sperling J, Green R, Clark S, Vawdrey D. An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV. Appl Clin Inform. 2014;5(1):299–312. https://doi.org/10.4338/ACI-2013-09-RA-0075.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Aronson ID, Cleland CM, Perlman DC, Rajan S, Sun W, Bania TC. Feasibility of a computer-based intervention addressing barriers to HIV testing among young patients who decline tests at triage. J Health Commun. 2016;21(9):1039–45. https://doi.org/10.1080/10810730.2016.1204382.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Felsen UR, Cunningham CO, Zingman BS. Increased HIV testing among hospitalized patients who declined testing in the emergency department. AIDS Care. 2016;28(5):591–7. https://doi.org/10.1080/09540121.2015.1120268.

    Article  PubMed  Google Scholar 

  38. Czarnogorski M, Brown J, Lee V, Oben J, Kuo I, Stern R, et al. The prevalence of undiagnosed HIV infection in those who decline HIV screening in an urban emergency department. AIDS Res Treat. 2011;2011:879065. https://doi.org/10.1155/2011/879065.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Haukoos JS. The HIV Testing Using Enhanced Screening Techniques in Emergency Departments Trial (HIV TESTED) Denver Health and Hospital Authority, Alameda County Medical Center, Johns Hopkins University, University of Cincinnati; 2013-present.

  40. Hodges R, DiOrio M. 2016 HIV/AIDS Surveillance Epidemiologic Report for Ohio In: Bureau Of Infectious Diseases ODoH, editor. 2016.

  41. Bert F, Gualano MR, Biancone P, Brescia V, Camussi E, Martorana M, et al. Cost-effectiveness of HIV screening in high-income countries: a systematic review. Health Policy. 2018;122:533–47. https://doi.org/10.1016/j.healthpol.2018.03.007.

    Article  PubMed  Google Scholar 

  42. Sood N, Wagner Z, Jaycocks A, Drabo E, Vardavas R. Test-and-treat in Los Angeles: a mathematical model of the effects of test-and-treat for the population of men who have sex with men in Los Angeles County. Clin Infect Dis. 2013;56(12):1789–96. https://doi.org/10.1093/cid/cit158.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Sorensen SW, Sansom SL, Brooks JT, Marks G, Begier EM, Buchacz K, et al. A mathematical model of comprehensive test-and-treat services and HIV incidence among men who have sex with men in the United States. PLoS One. 2012;7(2):e29098. https://doi.org/10.1371/journal.pone.0029098.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57. https://doi.org/10.1016/s0140-6736(08)61697-9.

    Article  PubMed  Google Scholar 

  45. CDC. PrEP 101. In: National Center for HIV/AIDS VH, ST, and TB prevention, editor. 2018.

  46. • Ridgway JP, Almirol EA, Bender A, Richardson A, Schmitt J, Friedman E, et al. Which patients in the emergency department should receive preexposure prophylaxis? Implementation of a predictive analytics approach. AIDS Patient Care STDs. 2018;32(5):202–7. https://doi.org/10.1089/apc.2018.0011. Examining an approach to to PrEP in the ED.

    Article  PubMed  Google Scholar 

  47. Nyaku AN, Williams LM, Galvin SR. Comparison of HIV testing uptake in an urban academic emergency department using different testing assays and support systems. AIDS Patient Care STDs. 2016;30(4):166–9. https://doi.org/10.1089/apc.2015.0297.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA

    Malcolm Hoshi, Justin Yax & Jonathan Glauser

  2. Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, USA

    Malcolm Hoshi, Justin Yax & Jonathan Glauser

  3. Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Joshua Niforatos

  4. University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA

    Justin Yax

Authors
  1. Malcolm Hoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joshua Niforatos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justin Yax
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan Glauser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Malcolm Hoshi.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Infectious Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hoshi, M., Niforatos, J., Yax, J. et al. HIV Testing in the Emergency Department. Curr Emerg Hosp Med Rep 6, 79–85 (2018). https://doi.org/10.1007/s40138-018-0161-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40138-018-0161-x

Keywords

Search

Navigation