Universal Rapid HIV Screening in the Emergency Department: A Model from Patient Entry to Definitive Care

Sunday, November 1, 2009

Rebecca Navarro, MSN, RN, CEN, SANE-A
Center of Hope, Wishard Health Services, Indianapolis, IN
Lee Wilbur, MD
Wishard Center of Hope; Department of Emergency Medicine, Indiana University, Indianapolis, IN
Leslie B. Weaver, MSW, LSW
Emergency Department - Center of Hope, Wishard Health Services, Indianapolis, IN

Learning Objective 1: identify three methods utilized in a pilot study for universal HIV screening in the emergency department.

Learning Objective 2: identify five steps from patient entry to definitive care for rapid HIV testing at a Level I Trauma Center.

Universal Rapid HIV Screening in the Emergency Department:  A Model from Patient Entry to Definitive Care

Background:  Previous HIV testing models in emergency departments (ED) describe referral to definitive care with targeted screening:  however we propose a model to acheive universal screening in the ED whild providing reliable follow-up with Infectious Disease

Objectives:  We hypothesize a universal HIV screening program to be feasible in the ED using external personnel and short-term social work clinic to integrate newly diagnosed HIV positive patients into definitive care

Methods:  A prospective observational study was conducted at a level 1 trauma center with an annual census exceeding 100,000.  Patients aged 18-64 years, without known HIV disease, were identified by an informatics system at triage or upon ambulance arrival.  Certified counselors from local HIV organizations served as external testing personnel.  Follwing informed consent, testers performed a HIV test using the Ora Quick Advance oral swab.  Western-Blot tests were sent for screen-positive patients.  Prior to ED discharge, testers scheduled screen-positive patients for a 1-week follow-up in a short-term social work clinic.  Patients then received confirmatory test results and additional post-test counseling.  The social worker then scheduled the patient in the Infectious Disease clnic.  Patient enrollement rotated from morning, to evening, to night shifts in weeks 1,2,and 3 respectively.  The fourth week entailed 24 hour coverage.  Statistics were performed using SAS version 9.1 and our institutional review board approved the study.

Results:  A total of 1193 patients were offered HIV screening and 1074 (90%) consented.  Four patients were screen-positive (0.33%) and 2 were confirmed (0.18%).  Both patients were compliant with social work and Infectious Disease follow-up.  Niether of the patients presented to the ED for AIDS defining illness.

Conclusiion:  Universal HIV screening and reliable referral to definitive care is feasible in the ED using external testing personnel and a short-term follow up model.

NOTE:  This pilot study resulted in the acceptance of an Americorp worker to the ED.  To date, the Americorp worker was tested an additional 550 individuals.  Additionally, the Obama Transition Team requested a summary of this project as a model for improving the delivery of healthcare while reducing costs.  Additional data will be available at the time of presentation at the conference.