Journal of the Louisiana State Medical Society
Rapid HIV Testing in a New Orleans Emergency Department is Effective in Identifying New HIV Diagnoses and in Linking Patients to Care
Lauren E. Richey, MD, MPH; Elizabeth J. Carpenter, MD; James M. Barbeau, MD, JD; Christiane M. Hadi, MD, MPH
A retrospective chart review of patients who agreed to a rapid HIV test in the emergency department in the initial year of institution of the rapid test was conducted. Out of 8,204 patients, 99 were newly diagnosed with HIV in the first year of the institution of the rapid HIV test (1.2%). Eighty-five (86%) had a documented referral to the infectious disease clinic, and 59 (60%) were linked to care within one year of diagnosis. The majority (58%) of the patients with a new diagnosis of HIV had been seen in the Interim Louisiana State University Public Hospital (ILPH) healthcare system in the five years prior to their diagnosis. Forty-nine percent of the patients met diagnostic criteria of AIDS at diagnosis. Rapid HIV testing in the emergency department is an effective way to find previously undiagnosed patients and link them to subspecialty care.
BACKGROUND In the United States, there are more than 1 million people living with HIV/AIDS. 1 It is estimated that a quar- ter of them are unaware of their infection and are at risk of transmitting the virus to others. 1 In September of 2006, the CDC recommended that in order to identify these patients early in the course of their disease that HIV screening be part of routine medical services, offered to every patient aged 13 to 64, on a voluntary opt-out approach. 2 Identifying patients early serves two purposes; 1) to improve an indi- vidual patient’s prognosis by linking the patient to care at an earlier stage of the disease and 2) to prevent transmission of the virus by patients who are unaware of their infection. 3 Routine HIV testing has been shown to be cost-effective in both high- and low-prevalence settings, 4 and ameta-analysis of 11 studies has shown that patients who are aware of their HIV infection decrease risk behaviors. 5 In 2002, a rapid test to detect HIV was approved by the FDA. This test was comparable to available HIV tests and was capable of providing results within 20 minutes. 6 The rapid test allowed for more efficient HIV testing because it eliminated the need for a second visit to obtain results. 7 It also allowedmore patients to receive the result of their test. 8 This rapid test allowed for HIV screening to be performed in high-paced settings such as emergency rooms. Emergency department patients are known to have a higher prevalence of HIV than the general population and are a potential place to identify patients who do not have traditional risk factors. 2,9,10 One possible explanation for the increased preva-
lence of unknown HIV infection in emergency departments is that these patients may not have access to primary care or routine HIV testing in the outpatient setting. Uninsured patients in emergency departments have been shown to have a higher prevalence of HIV than insured patients. 11 The Louisiana Department of Health and Hospitals’ Office of Public Health reported 6,834 persons living with HIV/AIDS in the New Orleans Metropolitan Area at the end of 2009. 12 The number of new HIV diagnoses in Loui- siana increased from 979 in 2005, to 1,152 in 2007, to 1,262 in 2009, and 31% of these new diagnoses were in the New Orleans Metropolitan area. 12,13 Twenty-four percent of the newly diagnosed patients had AIDS, which demonstrates advanced disease at the time of diagnosis. 13 The Interim Louisiana State University Public Hospital (ILPH), part of the Medical Center of Louisiana New Orleans (MCLNO), primarily serves uninsured and underinsured patients. The system is also capable of linking patients to high-quality subspecialty care, regardless of insurance status. This makes it an excellent location to identify previously undiagnosed HIV infections. ILPH’s Emergency Department began offer- ing free rapid HIV tests to its patients in February of 2008. The purpose of this study is to determine how many new HIV infections were diagnosed with the test and whether these patients were successfully linked to subspecialty care. METHODS Rapid HIV testing was instituted on an opt-in basis beginning in February 2008 in the Emergency Department
28 J La State Med Soc VOL 166 January/February 2014
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