Use of HIV testing in ED hits snags

Studies find that patients are amenable but that medical staffs often don't have time to carry it out, and links to care can be awkward.

By Victoria Stagg Elliott, AMNews staff. June 4, 2007.

Almost everyone should be offered an HIV test.

At least that's the take-home message of the Centers for Disease Control and Prevention guidelines issued in September 2006 with the support of many medical societies, including the American Medical Association.

Now, emerging data from the earliest attempts to study the implementation of this directive suggest that many patients will take advantage of the opportunity to be tested. Studies also are showing, though, that fully integrating this policy into medical practice can be difficult logistically.

Several presentations at the Society for Academic Emergency Medicine meeting in Chicago last month documented that a significant percentage of patients presenting to emergency departments for care said "yes" when offered a rapid HIV test.

"Patients think this is a great idea. People coming in for sprained ankles and cuts on their hand who didn't think they were going to go to the hospital that day -- let alone get an HIV test -- were willing," said Dr. Jeremy Brown, research director of the Dept. of Emergency Medicine at George Washington University Medical School in Washington, D.C.

His study found that about 60% of those offered the test between September and December 2006 consented. Of the 2,476 who agreed, 26 had preliminary positive results. Nine of these were verified as positive by later testing. But significant problems emerged with regard to confirming preliminary results or connecting patients to appropriate care. For various reasons, 13 patients were lost to follow-up.