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An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
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HIV testing in US EDs, 1993-2004.

Roland C Merchant1, Bethany M Catanzaro

  • 1Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. rmerchant@lifespan.org

The American Journal of Emergency Medicine
|August 18, 2009
PubMed
Summary

Human immunodeficiency virus (HIV) testing rates in US emergency departments (EDs) remain low, with poor adherence to CDC guidelines over a 12-year period. Testing is more frequent among minority groups and those with public or no insurance.

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Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Healthcare Access

Background:

  • Emergency departments (EDs) are critical access points for healthcare, yet HIV testing rates and adherence to screening guidelines remain suboptimal.
  • Understanding the incidence and demographic variations in HIV testing within EDs is crucial for targeted public health interventions.
  • Previous studies have highlighted disparities in healthcare access and outcomes, necessitating an examination of HIV testing patterns in diverse patient populations.

Purpose of the Study:

  • To estimate the incidence rates (IRs) of human immunodeficiency virus (HIV) testing among patients aged 13–64 in US emergency departments (EDs).
  • To assess ED compliance with Centers for Disease Control and Prevention (CDC) recommendations for HIV testing in specific risk groups (nonsexual blood/body fluid exposures, STDs, sexual assaults).
  • To determine if HIV testing in EDs varies based on patient demographic characteristics and insurance status.

Main Methods:

  • Analysis of National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 1993–2004, focusing on ED visits.
  • Identification of relevant patient encounters using diagnosis and cause codes for nonsexual blood/body fluid exposures, STDs, and sexual assaults.
  • Estimation of HIV testing incidence rates and use of multivariable logistic regression to calculate odds ratios (ORs) for demographic variations in testing.

Main Results:

  • The average HIV testing incidence rate (IR) in US EDs for patients aged 13–64 was 0.31% between 1993 and 2004.
  • HIV testing was performed in 35.1% of patients with nonsexual blood/body fluid exposures, 20.4% with sexual assaults, and only 2.6% with STDs.
  • HIV testing was significantly more frequent among Hispanic and Black patients, those with Medicaid, Medicare, or self-pay/no charge insurance, and those in northeastern US EDs.

Conclusions:

  • HIV testing rates in US EDs are low and have shown minimal change over a 12-year period, indicating a persistent public health concern.
  • Compliance with CDC recommendations for HIV testing in EDs is inadequate, particularly for patients with STDs and sexual assaults, despite identified risks.
  • Disparities in HIV testing exist, with higher testing rates observed among Hispanic and Black patients, and those lacking private health insurance, suggesting potential inequities in screening practices.