New research suggests that hospital emergency departments could be key to identifying and treating those at risk of HIV through targeted testing. A study conducted by researchers in the US found that offering HIV tests to patients in emergency departments led to a significantly higher rate of diagnosis, with many patients unaware of their status prior to the test. The findings suggest that emergency departments could play a critical role in the fight against HIV, opening up new opportunities for early intervention and improved outcomes for those living with the disease. Here’s what you need to know about the potential of targeted testing for HIV in hospital emergency departments.
A recent article has shown that targeted HIV testing in emergency departments (ED) has the potential to significantly increase diagnoses. Researcher Dr. Juan González del Castillo, head of the Infectious Disease Group of Spanish Emergency Medicine Society (SEMES), states that early diagnosis is essential for both the avoidance of the spread of HIV infection and for improving patient prognosis. However, a significant proportion of infected people worldwide remain undiagnosed, a problem also faced by the developed world, where late diagnosis rates are close to 50%. In Spain, this figure is 48%. To address this issue, SEMES released guidance in 2021, recommending that HIV testing and appropriate referral to specialists for follow-up are promoted among individuals attending ED for treatment related to one of six specified conditions or behaviors commonly associated with HIV infection.
The analysis of data from 34 EDs in Spain revealed that after targeted testing was implemented, the number of HIV diagnoses more than tripled. The number of HIV tests ordered in ED increased by 75%, with the number of HIV diagnoses increasing over three-fold, representing an increase of 220%, when ED attendance figures were factored in. The positive test rate also increased from 0.92% to 1.67%, as expected, since previous studies have shown a high positive rate in the six conditions and behaviors covered by the SEMES recommendations.
The study also showed a significant increase in HIV testing in all of the recommended areas, apart from practice of chemsex. A significant reduction in the time between ED attendance and the first appointment with an HIV specialist was also observed, as well as the initiation of antiviral treatment.
Data from SEMES shows that to date, a total of 103 EDs have implemented the recommendations, with 113,030 tests performed and 888 new diagnoses made in 2021 and 2022. Assuming that one diagnosis prevents two to four new cases, the new diagnoses in these two years could have led to 1,756 to 3,512 new cases being avoided.
Dr. González del Castillo emphasizes that the role of EDs in HIV detection is pivotal and must be recognized and promoted, whatever the strategy and wherever people are in the world. Targeted HIV screening in the ED can be impactful, more cost-effective, and better accepted by both patients and physicians than universal testing, and could play a crucial role in reversing the downward trend in HIV diagnoses in Spain, reducing the spread of HIV and the high rates of late diagnosis.
However, implementing universal testing strategies like those used in England, where explicit consent for HIV testing is not required, could be difficult in Spain, where such consent is necessary, and where ED physicians may be reluctant to order tests that will not help them diagnose and treat the patient’s presenting condition. Nevertheless, recommendations for hepatitis B and C testing are also being worked on, with many EDs starting to do them at the same time as HIV.
In conclusion, targeted testing for HIV in hospital emergency departments has shown promising results and has the potential to increase early detection and ultimately, improve patient outcomes. With the high rate of undiagnosed individuals and the significant impact of late diagnoses, this approach could be a valuable tool in the fight against HIV/AIDS. By identifying and treating those who are unaware of their HIV status, we can work towards decreasing new infections and achieving the goal of an AIDS-free generation. As the medical community continues to explore new strategies and interventions, targeted testing in emergency departments should be a priority to help reduce the burden of HIV on our society.
