Feasibility of an emergency department-based, risk-targeted voluntary HIV screening program

G. D. Kelen, D. A. Hexter, K. N. Hansen, R. Humes, R. N.D. Vigilance, M. Baskerville, T. C. Quinn

Research output: Contribution to journalArticle

Abstract

Study objective: To assess the feasibility and effectiveness of an emergency department-based, risk-targeted voluntary HIV screening program. Methods: We prospectively enrolled consenting adult IV drug users (IDUs) not known to have HIV infection in the ED of a large inner-city hospital with a high rate of HIV infection among patients during a 10-week trial. Study patients were given confidential HIV protest and risk-reduction counseling, with 10- to 14-day on-site ED follow-up. Follow-up included posttest counseling, reinforcement of risk-reduction practices, and a $10 incentive to cover transportation costs. HIV seropositive patients were referred to the hospital HIV clinic for further evaluation and treatment. Results: Of 200 eligible IDUs, 168 (84%) consented to HIV testing. Of the 104 (62%) who returned for follow-up, 17 (16%) tested positive for HIV. Of these patients, 6 (35%) kept their initial hospital HIV clinic referral appointment, a rate consistent with the experience of the hospital HIV clinic. Of nine patients in whom CD4+ counts were performed at time of the visit, three (33%) had counts less than 200. At 3-month follow-up, 4 of 20 active IDUs (20%) had reportedly ceased drug use because of the program. The complete program cost was an estimated $16,659, $99 per enrolled patient and $521 per HIV-positive patient. Conclusion: An ED-based, risk-targeted HIV screening program is feasible and over time could detect a significant number of asymptomatic HIV- infected individuals, including those who should receive antiretroviral therapy and prophylaxis for Pneumocystis carinii pneumonia therapy (CD4+ count less than 200). An additional benefit of ED-based HIV screening in high-prevalence EDs is the opportunity to conduct successful risk-reduction counseling in some high-risk individuals.

Original languageEnglish (US)
Pages (from-to)687-692
Number of pages6
JournalAnnals of emergency medicine
Volume27
Issue number6
DOIs
StatePublished - Jan 1 1996

ASJC Scopus subject areas

  • Emergency Medicine

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