Abstract of Distinction: Universal HIV Screening in the Emergency Department

Introduction: One in seven HIV-positive individuals — more than 168,000 people in the United States (US) — do not know they are infected, and undiagnosed HIV patients account for up to two-thirds of new infections. Miami-Dade County is number one in the country for new HIV infections, a major public health concern. Black/African Americans (19%) and Hispanics (68%), some of the biggest populations in Miami Dade, experience significant health disparities related to HIV. With whole communities at risk, it is important to adopt communitywide approaches and solutions. The constant flow of patients into the Emergency Department (ED) presents an opportunity to identify undiagnosed patients and provide them with a seamless path to treatment. By implementing routine HIV screening in the ED as a hospital policy, we hope to reduce the number of undiagnosed and out of care individuals, change public perceptions, and overcome the stigma of HIV testing.

Methods: This project uses an opt-out model and integrates routine HIV screening into the existing ED workflow to identify positive patients and link or re-link them to care. Any patient in the ED who had laboratory tests performed and did not opt-out of the screening was included.

Results: Since implementation 3 months ago, 7,437 patients were screened, 195 patients tested positive for HIV. The mean age was 49 (SD=13), 62% were male and 69% self-identified as black or African American. The percentage of self-identified Hispanics was 27%. 2 individuals (1%) had previously tested negative and 7% were not aware of their HIV status, leaving 86% of the patients as known HIV positives (data not reported for 11 patients). At the time of this abstract, 37 patients (19%) have been linked to care through this screening process (48% Black or African American and 32% Hispanic), with 38% already in care at the time of screening and 35% in the process of being linked. 25 patients were identified as being co-infected with HCV. Since current linkage is ongoing, results will be updated before the conference.

Conclusions: Studies show that there is a 60-70% reduction in high-risk behaviors of patients who know they are diagnosed with HIV. For many of these patients, the ED may be their only interface with healthcare, making ED-based screening a critical opportunity to identify HIV positive patients. Routine screening is also a proven means of reducing stigma, increasing diagnosis, and changing attitudes about disease and prevention. Identifying newly infected patients and those out of care may help prevent the spread of HIV in the community.