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A comparison of HIV testing in the emergency department and urgent care
Douglas A E White1, Paul T Cheung, Alicia N Scribner
1Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA 94602, USA.
Background:
Although national guidelines recommend universal human immunodeficiency virus (HIV) testing, emergency departments (EDs) may choose to limit testing to certain patients, such as those triaged to urgent care (UC).
Objective:
To compare the results of rapid HIV testing in an urban ED with an affiliated UC.
Methods:
This was a retrospective analysis of an HIV testing program that included screening, which was initiated by triage nurses, and diagnostic testing, which was initiated by clinicians. Eligible patients were ≥ 12 years old and medically stable.
Results:
From April 2005 through December 2006, HIV tests were completed in 6196 (8.3%) of the 74,331 ED visits and 3256 (8.8%) of the 37,169 UC visits. Screening accounted for 5009 (80.8%) of the ED tests and 2914 (89.5%) of the UC tests, and diagnostic testing accounted for the remainder. Eighty (1.3%) of the ED tests and 21 (0.6%) of the UC tests were positive (p = 0.0024). Compared with newly diagnosed HIV-positive ED patients, HIV-positive UC patients were less likely to have CD4 counts < 200 cells/μL (adjusted odds ratio 0.19, 95% confidence interval 0.05-0.65).
Conclusion:
Although the yield of HIV testing is greater among ED patients, UC patients are diagnosed at a less advanced stage of illness.
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