October 2011: Volume 37, Number 10
Study Calls for More HIV Testing in EDs
A nationwide survey of emergency departments (ED) found wide variation in human immunodeficiency virus (HIV) testing practices and limited familiarity with and implementation of Centers for Disease Control and Prevention (CDC) testing recommendations (Ann Emerg Med 2011;58:S10– 16). The findings point to the need to improve HIV testing rates, particularly in community hospital EDs.
The survey was aimed at evaluating HIV testing practices in both academic medical center and community hospital EDs and assessing compliance with 2006 CDC recommendations that call for routine, non-targeted HIV screening. The authors also sought to assess attitudes about and barriers to performing ED-based HIV testing.
Overall, there were 249 survey respondents, including 99 academic medical center and 150 community hospital EDs. While nearly all reported routinely testing for chlamydia and gonorrhea, just 56% perform HIV testing. Only half indicated that they were familiar with the 2006 CDC recommendations, and a mere 16% had incorporated any of the recommendations in practice. Slightly more than two-thirds of respondents reported having implemented diagnostic HIV testing; another quarter employ targeted screening.
The survey also exposed considerable differences in HIV testing practices between academic and community EDs. Academic EDs were more likely to provide free testing, to receive dedicated funding for HIV testing, and to perform non-targeted testing. Community EDs said that the high price tag and space requirements contributed to limited HIV testing, whereas academic institutions cited administrative hurdles.
Overall, respondents from both types of EDs agreed that HIV testing should be part of routine, preventive services that EDs provide to reduce the number of individuals living with undiagnosed HIV infections.