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Indicator condition-based and risk-factor guided HIV testing in the emergency department: An effective strategy to
Alessandro Lazzaro1, Camilla Tincati2, Francesco Romano1
1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
Objectives:
This study evaluated the feasibility and effectiveness of clinical indicator conditions (ICs)-guided and epidemiological risk factors (RF)-based provider-initiated HIV testing in Italian urban Emergency departments (EDs) within the current opt-in legal framework.
Methods:
A multicenter cross-sectional study was conducted from September 2022 to September 2023 in the EDs of two urban hospitals in Rome and Milan. Adults with one or more pre-defined ICs and/or RFs were offered HIV testing. Demographic, clinical and historical data were collected, and multivariable logistic regression was used to identify predictors of HIV test reactivity.
Results:
Among 826 enrolled participants, 12 new HIV diagnoses were made, yielding a reactivity rate of 1.45% (95% CI 0.82-2.54). ICs associated with test reactivity included mononucleosis-like illness, seborrheic dermatitis/exanthema, and pneumonia. Key RFs associated with positivity included being a migrant from a high-HIV-endemic country, MSM status, and injection drug use. Most newly diagnosed individuals had CD4+ T lymphocytes counts <350 cells/µL, and missed opportunities for earlier testing were identified in 66.7% of evaluable cases.
Conclusion:
Provider-initiated HIV testing in EDs guided by ICs and RFs is feasible and effective within the Italian opt-in framework, enhancing early HIV case detection, supporting broader implementation as part of national testing strategies.
