Routine HIV Testing Within the ED of a Major Trauma Centre
Between March and July 2013, 9297 ED attendees had an FBC taken, with 2828 of 9297 (30%) accepting an HIV test. This constitutes a 12-fold increase in the HIV testing rate compared with 2 months prior to the study [72 tests (2.4%); no tests HIV positive; p < 0.001]. A total of 1527 patients (54%) were male, and the median age was 48 years. The numbers of patients tested for HIV within the different age categories were: 16–30 years, 877 (31%); 31–40 years, 650 (23%); 41–60 years, 764 (27%); and > 60 years, 537 (19%). Those receiving HIV tests were ethnically diverse (17 ethnicities). Most who were tested self-identified as British (33%), Bangladeshi (18%), African (3%), Pakistani (3%) and Caribbean (3%).
Nineteen ED attendees had an HIV-positive blood test, equating to 1% of the population tested; for comparison, the known Public Health England (PHE) prevalence for Tower Hamlets is 0.6%.
Eight of the nineteen diagnoses were new diagnoses (8/2828; 0.28%). Two of these eight patients were found to be seroconverting based on viral load, avidity and HIV antibody results. All eight presented with clinical indicators for HIV infection (median CD4 count 256 cells/μL; interquartile range 42–348 cells/μL), such as tuberculosis, significant weight loss, unexplained diarrhoea and vomiting, and Guillain–Barre Syndrome. Of the 11 previously diagnosed patients, six had been lost to follow-up (LTFU) for ≥ 1 year and all had discontinued antiretroviral therapy (ART). The remaining five patients were engaged with HIV care but did not disclose their status in the ED setting. We were able to link 13 patients to HIV services (seven newly diagnosed and six LTFU) with eight eligible patients commencing ART. Contact tracing was successfully completed in 13 of 14 cases, including the HIV testing of an untested exposed infant and an untested child.
In the staff survey, 100% of respondents had been trained and 95% agreed that routine HIV testing should be rolled out permanently in the ED. However, the uptake rate was very low, at 9.5%. Nineteen members of staff completed the survey, of whom 18 agreed with the statement that 'opt out testing should be continued in the ED'. One hundred per cent of staff reported finding it easier to offer an HIV test as part of a routine policy rather than based on clinical suspicion.
Results
Between March and July 2013, 9297 ED attendees had an FBC taken, with 2828 of 9297 (30%) accepting an HIV test. This constitutes a 12-fold increase in the HIV testing rate compared with 2 months prior to the study [72 tests (2.4%); no tests HIV positive; p < 0.001]. A total of 1527 patients (54%) were male, and the median age was 48 years. The numbers of patients tested for HIV within the different age categories were: 16–30 years, 877 (31%); 31–40 years, 650 (23%); 41–60 years, 764 (27%); and > 60 years, 537 (19%). Those receiving HIV tests were ethnically diverse (17 ethnicities). Most who were tested self-identified as British (33%), Bangladeshi (18%), African (3%), Pakistani (3%) and Caribbean (3%).
Nineteen ED attendees had an HIV-positive blood test, equating to 1% of the population tested; for comparison, the known Public Health England (PHE) prevalence for Tower Hamlets is 0.6%.
Eight of the nineteen diagnoses were new diagnoses (8/2828; 0.28%). Two of these eight patients were found to be seroconverting based on viral load, avidity and HIV antibody results. All eight presented with clinical indicators for HIV infection (median CD4 count 256 cells/μL; interquartile range 42–348 cells/μL), such as tuberculosis, significant weight loss, unexplained diarrhoea and vomiting, and Guillain–Barre Syndrome. Of the 11 previously diagnosed patients, six had been lost to follow-up (LTFU) for ≥ 1 year and all had discontinued antiretroviral therapy (ART). The remaining five patients were engaged with HIV care but did not disclose their status in the ED setting. We were able to link 13 patients to HIV services (seven newly diagnosed and six LTFU) with eight eligible patients commencing ART. Contact tracing was successfully completed in 13 of 14 cases, including the HIV testing of an untested exposed infant and an untested child.
In the staff survey, 100% of respondents had been trained and 95% agreed that routine HIV testing should be rolled out permanently in the ED. However, the uptake rate was very low, at 9.5%. Nineteen members of staff completed the survey, of whom 18 agreed with the statement that 'opt out testing should be continued in the ED'. One hundred per cent of staff reported finding it easier to offer an HIV test as part of a routine policy rather than based on clinical suspicion.
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