Targeted HIV screening in the emergency department

Ornella Spagnolello, Matthew J. Reed

Research output: Contribution to journalArticlepeer-review

Abstract

Despite considerable improvement in Human Immunodeficiency Virus (HIV) knowledge and
treatment in the last three decades, the overall number of People Living with HIV (PLHIV) is still rising
with up to one quarter being unaware of their HIV status. Early HIV diagnosis and treatment prolongs
life, reduces transmission, improves quality of life and is a cost-effective public health intervention.
The Emergency Department (ED) sees a large number of patients from marginalized and traditionally
underserved populations in whom HIV is known to be more prevalent and who may not attend
traditional services because of either cultural reasons or because of a chaotic lifestyle. This article
discusses the two main approaches to screening; ‘Opt-out’ screening offers testing routinely in all
clinical settings, and ‘Targeted’ screening offers testing to individuals presenting with indicator
conditions. There are many studies of ‘Opt-out’ ED HIV screening in urban areas of high HIV
prevalence. However, little is known about the effectiveness of ‘targeted’ HIV screening especially in
areas of low-prevalence. This review discusses the background to HIV screening in the ED and reviews
the evidence around ‘targeted’ HIV screening in adult EDs in different HIV prevalence settings
concluding that targeted HIV screening at the ED can be impactful, cost effective and well accepted
in the ED population, but its long-term implementation requires extra funding and increased staffing
resource limiting its application in low resources setting. Despite most evidence being from areas of
high-HIV prevalence, targeted screening might also be appropriate in low-HIV prevalence areas.
Original languageEnglish
JournalInternal and Emergency Medicine
DOIs
Publication statusPublished - 7 Feb 2021

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