1040 
Results from a New York City Emergency Department Rapid HIV Testing Program
Katerina Christopoulos*1, B Schackman2, G Lee3, R Green4, and E Morrison4
1San Francisco Gen Hosp, Univ of California, San Francisco, US; 2Weill Med Coll of Cornell Univ, New York, NY, US; 3Columbia Univ, Mailman Sch of Publ Hlth, New York, NY, US; and 4Columbia Univ Med Ctr, New York, NY, US
Background: The US Centers for Disease Control and
Prevention recommends expanded HIV screening in emergency departments (ED). The
additional value of ED testing programs remains controversial. We evaluated an
ED rapid HIV testing program in New York City to determine the yield of testing
and assess patient characteristics associated with a new diagnosis of HIV.
Methods: Patients underwent fingerstick Oraquick
Orasure testing in a counselor-based testing program funded by the New York
City Department of Health and Mental Hygiene (NYC DOHMH) in 2 ED affiliated with
Columbia University Medical Center in New York City in 2006 to 2007. Each ED
had 1 counselor available during business hours Mondays through Fridays. ED
providers could refer patients for testing, but most patients were offered
testing by counselors. Data were from the testing program database and
supplemented by electronic medical record review. Associations between
demographic variables and a new diagnosis of HIV were investigated using the
χ2 test and multivariate logistic regression.
Results: Of 69,398 ED visits during the times of
testing program operation, 2569 patients underwent rapid HIV testing.
Preliminary positive results were obtained on 31 patients (1.2%); all diagnoses
were confirmed by Western blot; 7 were found by electronic medical record
review to have been previously diagnosed with HIV, and 24 (0.9%) were
considered new diagnoses. In the multivariate analysis, being black (AOR 2.7,
95%CI 1.1 to 6.4, p = 0.03) and men who have sex with men (MSM) (AOR
11.8, 95%CI 4.5 to 30.9, p = <0.001) were significantly related to a
new diagnosis of HIV. Of the 24 patients, 17 had CD4 counts within 3 months of
diagnosis; the median CD4 count was 200 (range 4 to 516); 10 patients had encounters
with the medical center in the year prior to diagnosis, 7 of whom had visited
only the ED. Linkage to care as defined by a visit with an HIV specialty
provider was able to be documented for 17 of 24 (71%) of newly positive
patients. ED diagnoses accounted for 15.8% of all new HIV diagnoses at the
medical center in 2006 to 2007.
Conclusions: ED rapid HIV testing programs can
contribute substantially to HIV screening efforts and may identify persons with
previously undiagnosed HIV infection who are not tested in other hospital
settings. CD4 counts at the time of diagnosis may be lower than anticipated in
this type of setting, and linkage to HIV specialty care may be difficult,
despite testing program outreach to newly positive patients.
|
