HIV Screening in Emergency Department in Washington DC suburbs, A Two Year Community Hospital Experience

Background: At the end of 2006, CDC estimated 1,106,400 persons in the US were living with HIV and 56,300 new HIV infections occurred in the US. Approximately 1 in 5 (21%, or 232,700 persons) did not know they were infected. In 2006 prevalence of HIV/AIDS in Maryland was  32, 811 i.e. 619.5 cases per 100,000  and incidence was 2,144 cases 40.5 cases per 100,000 population and incidence of AIDS was 1,233 cases i.e. 23.3 cases per 100,000 population and there were 386 deaths from AIDS in 2006. Prince George’s County stands second after Baltimore city in the prevalence and incidence of HIV/AIDS in the state of Maryland and harbors 16 % of cases with HIV/AIDS (49% in Baltimore city).  In September 2006 CDC revised its guidelines and recommended “opt-out screening” and eliminated need for the separate consent form with objective to early diagnose and treat the HIV infected who are unaware of their status and bring them into the care. In 2007, CDC provided 16 states with funding for HIV program, MD is one of them. PGHC is one of 8 hospitals in MD receiving funding for a screening program. HIV screening has been started in PGHC ED since March 2008.

Objective: To determine if it is feasible to screen patients visiting emergency department for HIV and how acceptable it is for the patients and visitors in ED.

Methods: During a 2 year period (March 13,2008- May 31,2010), ED patients and visitors to PGHC ED who were 13 years and older were approached by trained HIV screeners and offered point-of-care rapid HIV testing after taking consent, using “ora-quick” test kits. Pre and post-test counseling was provided and if positive or indeterminate were confirmed by western blot and were involved in the HIV care through their PCP, PGHC Health Department or PGHC outpatient HIV clinic.

Results: Starting March 13, 2010 – May 31, 2010 a total of 6,123 patients and visitors coming to ED were tested after taking consent for HIV (required per hospital policy) by trained HIV Screeners. The mean patient age was 34 years; 6.9% were Hispanic, 89.4% were non-Hispanics and 3.5% did not reveal their ethnicity. Of non-Hispanics 89.4% were African American, 4% were Caucasians and rest were others. A total of 57.4% were female, 42.4% were males and 0.1% was transgender. Of the patients tested 91 (1.48%) were positive with mean age of 38.37, (19-91) of which 81 (89.01%) were African Americans, 1 (1.09%) was Caucasian 9(9.89%) were Hispanics. Of these 52 (57.14%) were males, 38(41.75%) were females and 1 (0.01%) was transgender. We also conducted a random sample survey for acceptability of HIV testing in Emergency Department when we found 76% of the patients and visitors supported the Screening for HIV in ED.

Conclusions: Emergency department is a good place to screen patients for HIV and bringing HIV positive patients in care. We think CDC recommendations should be universally accepted for “opt-out screening”.