Efficacy of an Emergency Department-Based HIV Screening Program in the Deep South

Residents of the Deep South, especially African Americans, continue to be disproportionately affected by HIV/AIDS. The current report describes an Emergency Department (ED)-based HIV screening program in the Deep South using CDC's 2006 recommendations for rapid testing and opt-out consent.

From May 2008 to March 2010, patients presenting for medical care in the ED -- from 10 a.m. to 10 p.m., Monday through Friday -- were offered HIV screening. Those eligible for screening were patients age 18 or older who had no previous history of HIV tests, were English-speaking, and were not incarcerated, medically unstable or otherwise able to decline testing.

The OraQuick rapid HIV 1/2 antibody test was used to screen all patients. Patients whose results were nonreactive were referred to anonymous testing sites in the community for further testing. Patients whose tests were reactive had confirmatory Western blot and CD4 counts drawn and were brought back to the ED for disclosure of the results. All the patients who were confirmed HIV-positive via reactive Western blot were referred to the hospital-based infectious disease clinic or the county health department.

A total of 8,922 patients were approached, of whom 7,616 were tested (85.4 percent acceptance rate). Ninety-one percent of the patients tested were African American. Having recently been tested for HIV was the most common reason for declining. Of those tested, 1.7 percent were confirmed HIV-positive by Western blot; 95.2 percent testing positive were African American. Patients testing positive had an average CD4 count of 276 cells/µl; 42 percent of the positive patients had CD4 counts of 200/µl or less -- consistent with an AIDS diagnosis. Of those patients with reactive oral swab results, 88.4 percent returned for Western blot results, and 75 percent of patients attended their first clinic visit.

"We have been able to successfully carry out an ED-based HIV screening program in a resource-poor urban teaching facility in the Deep South," the authors concluded. "We define our success based on our relatively high test acceptance rate and high rate of attendance at first clinic visit. Our patient population has a relatively high undocumented HIV prevalence and are at advanced stage of disease at the time of diagnosis."

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