HIV Screening in an Urban Emergency Department The Highland Hospital Experience
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HIV Screening in an Urban Emergency Department The Highland Hospital Experience Douglas White, MD Alameda County Medical Center - Highland Hospital Oakland, CA
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HIV Screening in an Urban Emergency Department The Highland Hospital Experience. Douglas White, MD Alameda County Medical Center - Highland Hospital Oakland, CA. Scope of the Problem. Scope of the Problem in U.S. >1,000,000 people in U.S. with HIV/AIDS 25% unaware - PowerPoint PPT Presentation
Transcript of HIV Screening in an Urban Emergency Department The Highland Hospital Experience
HIV Screening in an Urban Emergency Department
The Highland Hospital Experience
Douglas White, MDAlameda County Medical Center -
Highland Hospital Oakland, CA
Scope of the Problem
Scope of the Problem in U.S.
• >1,000,000 people in U.S. with HIV/AIDS– 25% unaware
• 40,000 new HIV infections/year• Barriers to testing
– Accessibility, fear, confidentiality, cost• 30% people testing positive do not return for
their results
Why rapid HIV testing?• Increase testing rates• More people learn results• Enables testing in non-traditional settings
– Emergency Departments– Outreach– Private homes
Highland Hospital• Urban, academic, teaching hospital• Emergency Department
– Regional trauma center– Emergency Medicine Residency– 70,000 patient visits/year– Diverse and Indigent patient population– Staff 120 nurses
Highland Project Overview• Feasibility Study
– CDC-funded, 2 year– Nursing-initiated HIV screening at triage– Routinely offer HIV testing to all eligible patients– Consent, testing, result disclosure (negatives)
performed by nursing staff– ED physicians disclose preliminary positive– Streamlined testing and counseling protocol
Bedside Testing
Oraquick ADVANCE HIV-1/2
Project Results - Basic Counts1/05 - 2/06
Number tested 6,283
Number Reactive Tests / Preliminary Positive 84 (1.3%)
Confirmed Positives 82 (98%)
Number False Positives 2 (2%)
False Negatives 1 (.016%)
Number Linked to Care and Treatment Services 68/82 (83%)
Results - Patient Satisfaction Newly Diagnosed Positives
• 96% rated experience as good - excellent
• 4% rated it as poor
Conclusion
• Routine, voluntary HIV screening in an urban ED using indigenous staff is feasible
• Rapid testing with OraQuick ADVANCE using oral fluid is easy to perform– 120 nurses with minimal training
• The rapid test performance was in accordance with manufacturer’s reported accuracy
• Patient satisfaction is high
OTC Application
• Many barriers still exist when seeking HIV testing– Accessibility– Stigma/fear– Informed Consent– Counseling– Internal Resources
• An OTC test would provide the public with more HIV testing options
