New research adds support for ED at-risk testing

Strategy reaches high-risk heterosexuals

Coverage of the 2001 IDSA Conference

A study conducted at the University Hospitals of Cleveland in Ohio adds to the growing body of research that suggests it’s a good strategy to offer HIV testing to patients admitted to hospital emergency departments. "People that are in HIV high-risk groups . . . use traditional HIV testing sites, but offering testing to emergency room patients reaches a different group that’s at risk, such as African-American women," says Michelle Kucia, Ryan White grants administrator for the University Hospitals of Cleveland. During a five-month period, investigators compared 123 people tested for HIV at a local clinic with 105 people who were tested in the emergency department after being admitted for common illnesses, such as sexually transmitted diseases (STDs), minor trauma, upper respiratory infection, or pelvic inflammatory disease, according to a study that was presented at the 39th Annual Meeting of the Infectious Diseases Society of America (IDSA), held Oct. 25-28, 2001, in San Francisco.

Researchers found that 97 (92%) of those tested in the emergency department were African-American and eight were Caucasian. Also, 63 (60%) were female. By comparison, of the population tested at the local HIV clinic, 79 (64%) were Caucasian, 25 (21%) were African-American, and the rest were mixed-race, Asian-American, and Hispanic. Of those tested at the clinic, 45 (36%) were female.

Also, the people tested in the emergency department were more likely to be heterosexual, have a history of STDs, and have prior intravenous drug use compared with those tested at the clinic. Men who have sex with men (MSM) were more likely to be tested at the HIV clinic, as were those who had sex with a known HIV-infected partner.

The study found no significant difference in the number of positives found in the emergency room vs. the HIV clinic, Kucia says. "By offering testing in the ER, we got people to think about HIV infection," Kucia says. "Especially at a time when women are coming to the rapid care center for something STD-related or prenatal, this gets them to think about risk and transmission."

Grants covered the cost of emergency department HIV testing, and the project included two medical students who would go to the rapid care center, make contact with patients, give them background information about HIV, and then offer testing. Medical students would obtain the patients’ consent, and nurses would draw their blood. Patients were instructed to return within a week to the outpatient HIV clinic for their results, Kucia says.

"HIV tests are run for free through the Ohio Department of Health, but it was something our ER was very hesitant to do," Kucia says. "They didn’t want to deal with all of the counseling and giving patients results, and that’s why we had patients come to the HIV clinic for their results."