The CDC and national research organizations have recommended universal HIV screening, but physicians disagree on how to implement testing in busy emergency departments. Researchers at the University of Cincinnati Medical Center Emergency Department conducted a randomized trial to determine whether screening everyone in the emergency department was more efficient than targeted testing screening.
The researchers hypothesized that by using very broad criteria and applying sufficient resources to test all who met the criteria they would be able to detect almost as many individuals with HIV infection as in universal screening, and use fewer tests. In the trial, patients for universal screening were offered HIV testing regardless of risk factors whereas with patients for targeted screening researchers set very broad parameters and offered testing for any possible risk indicator they found using more criteria than usual.
The researchers offered screening to 9,572 patients who were randomized into either category. Results showed that targeted screening did not diagnose as many patients and did not require many fewer tests. Approximately 40 percent of universally screened individuals agreed to be tested and six of them tested positive for HIV. In the targeted screening group 47 percent agreed to be testing and three were diagnosed positive.
According to Michael Lyons, lead author of the study, results showed that this type of targeted screening using the broadest possible selection criteria was not better than universal screening. He acknowledged additional studies are needed to determine whether another method of selecting patients for screening would be more successful in limiting testing while finding more infected individuals.
The full report, "Randomized Comparison of Universal and Targeted HIV Screening in the Emergency Department," was published online in the Jounal of Acquired Immune Deficiency Syndromes (doi: 10.1097/QAI.0b013e3182a21611).
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