The Implementation of Opt-In Rapid HIV Testing in an Urban Emergency Department

In 2006 the CDC recommended that HIV testing be offered in all health care settings in an effort to increase the number of HIV-infected persons who are aware of their serostatus. Emergency departments (ED) are explicitly emphasized in the initiative as EDs often serve as a site for routine health care visits. In March 2013, the US Preventive Services Task Force released a drafted statement changing their assigned recommendation grade for routine HIV screening from a “C” to an “A”. Currently available commercial assays allow for increasingly early detection of HIV infection. Past studies have reported discouraging patient participation rates and feasibility evaluations for screening in the ED. An IRB-approved pilot study was developed to determine the feasibility of implementing a point-of-care (POC), opt-in, rapid HIV testing program in an urban, 54,000 volume, level 1 trauma center. The pilot program was performed over periods of 6 weeks and 10 weeks in the summers of 2011 and 2012, respectively. From Monday through Friday, for 8 hours/day, non-targeted English-speaking patients, between the ages of 18 and 64, triaged ESI level 3, 4, or 5 were offered a free bedside Oraquick Advance rapid, oral HIV test. Study personnel were trained in obtaining consent, administration of the test, disclosure of results and HIV counseling. A process for counseling and confirmatory testing of preliminary positives involved ED and infectious disease staff, social workers, and the State Health Department. Of 456 patients offered POC oral HIV tests, 422 (93%) consented to the test. The study period yielded one preliminary positive Oraquick ELISA, later invalidated via Orasure Western Blot by the Illinois Department of Public Health (IDPH). The mean age of participants was 38 years old; 50% had not previously received an HIV test. 64% of participants were minorities. Average test time was 24.5 minutes. High patient acceptance rate (93%) and minimal effect on ED flow suggest that rapid HIV testing is feasible in an emergency setting with additional staff support. The anticipated prevalence (≥ 0.1%) was not identified in this pilot.