Non-targeted HIV testing in the emergency department: not just how but where

ABSTRACT

Introduction: The emergency department (ED) has the potential to enhance early HIV diagnosis through HIV testing programs. How these are implemented is a subject of debate.

Areas covered: We describe the main HIV testing approaches: diagnostic testing, targeted screening, and non-targeted screening, and review ED-based non-targeted HIV screening studies conducted after 2006 among ≥5000 patients. As well as examining how testing is offered, we focus on where it is offered, through the patient’s journey from registration, via triage and the waiting room, to the bedside. Barriers to the testing offer, acceptance and performance were examined at each location.

While testing offer rates were higher at registration and triage, compared to the waiting room and bedside, this was sometimes at the expense of testing acceptance and performance. Variables affecting testing rates included type of consent, employment of external staff and type of testing: fourth generation serological testing versus rapid testing.

Expert commentary: These large studies shed light on the importance of where as well as how HIV testing is performed, and the ways in which the ‘where’ can influence non-targeted screening yields. This perspective enables testing approaches to be tailored to specific ED settings in order to maximize testing rates.

KEYWORDS:

• HIV
• HIV testing
• HIV diagnosis
• screening
• emergency department
• non-targeted
• opt-out

Declaration of interest

K Darling has received travel grants from MSD and Gilead Sciences and research grants from Gilead Sciences, paid to her institution. M Cavassini has received travel grants from Gilead and Abbvie, and research grants from Gilead and Viiv, paid to his institution. R Tan institution has received a travel grant from Gilead. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Funding

This manuscript was not funded.