Routine HIV Testing Within the ED of a Major Trauma Centre
Routine HIV Testing Within the ED of a Major Trauma Centre
Objectives UK guidelines recommend routine HIV testing for all medical admissions where the local prevalence exceeds 2 per 1000. We aimed to review uptake of HIV testing in the emergency department (ED) of one of the country's major trauma centres in a 3-month pilot study (March–June 2013).
Methods ED attendees already having blood tests were routinely tested for HIV (based on the recommendation being made to all to test when having blood taken). Uptake was determined using the surrogate marker of ED attendees who had full blood counts (FBCs) as the denominator. Newly diagnosed patients were linked to care and contacts tested. Staff completed an anonymous online survey to determine acceptability at the end of the pilot study.
Results A total of 2828 patients were tested over 3 months. Nineteen HIV-positive individuals were identified. Eight were newly diagnosed, of whom two were thought to be seroconverting. The prevalence of new diagnoses was 8/2828 (0.28%); for comparison, the Public Health England (PHE) actual prevalence for Tower Hamlets is 6.25/1000 (0.625%). Uptake for HIV testing was 30%, a significant increase from 72 tests performed in the 2 months prior (P < 0.001). Ninety-five per cent of respondents to the staff survey agreed that routine HIV testing should be rolled out permanently in the ED.
Conclusions Despite an average uptake rate, there were 19 positive tests: eight in patients who were newly diagnosed, six in patients who had been lost to follow-up, and five in patients who were known to be positive and linked to care. The staff survey indicated recognition of the importance of HIV testing in the ED. These persuasive data achieved short-term Clinical Commissioning Group (CCG) funding for routine ED testing.
Early diagnosis of and treatment for HIV infection prolong life, reduce transmission, improve quality of life and have been demonstrated to be a cost-effective public health intervention. However, in 2012 47% of new HIV diagnoses were late diagnoses, and 22% of the 98 400 people living with HIV in the UK remained undiagnosed. This is despite recommendations from the National Institute for Clinical Excellence (NICE) Public Health Committee and the UK's National HIV Testing guidelines that all patients accessing secondary care or those having planned venepuncture should be tested for HIV if the diagnosed prevalence of HIV exceeds 2 per 1000.
Low rates of HIV testing have been repeatedly demonstrated in hospital settings in the UK, even in those patients presenting with clinical indicators for HIV infection. The emergency department (ED) is a desirable target for HIV testing within hospitals as it serves a high-throughput population of diverse attendees. However, the focus on trauma and resuscitation as well as the 4-hour wait make it, understandably, logistically difficult to prioritize HIV testing initiatives. Our ED serves a population with a very high diagnosed prevalence of HIV (6 1000 population) - three times higher than the prevalence at which testing is routinely recommended. The busy ED is home to London's air ambulance and has 400 000 attendances per year.
Abstract and Introduction
Abstract
Objectives UK guidelines recommend routine HIV testing for all medical admissions where the local prevalence exceeds 2 per 1000. We aimed to review uptake of HIV testing in the emergency department (ED) of one of the country's major trauma centres in a 3-month pilot study (March–June 2013).
Methods ED attendees already having blood tests were routinely tested for HIV (based on the recommendation being made to all to test when having blood taken). Uptake was determined using the surrogate marker of ED attendees who had full blood counts (FBCs) as the denominator. Newly diagnosed patients were linked to care and contacts tested. Staff completed an anonymous online survey to determine acceptability at the end of the pilot study.
Results A total of 2828 patients were tested over 3 months. Nineteen HIV-positive individuals were identified. Eight were newly diagnosed, of whom two were thought to be seroconverting. The prevalence of new diagnoses was 8/2828 (0.28%); for comparison, the Public Health England (PHE) actual prevalence for Tower Hamlets is 6.25/1000 (0.625%). Uptake for HIV testing was 30%, a significant increase from 72 tests performed in the 2 months prior (P < 0.001). Ninety-five per cent of respondents to the staff survey agreed that routine HIV testing should be rolled out permanently in the ED.
Conclusions Despite an average uptake rate, there were 19 positive tests: eight in patients who were newly diagnosed, six in patients who had been lost to follow-up, and five in patients who were known to be positive and linked to care. The staff survey indicated recognition of the importance of HIV testing in the ED. These persuasive data achieved short-term Clinical Commissioning Group (CCG) funding for routine ED testing.
Introduction
Early diagnosis of and treatment for HIV infection prolong life, reduce transmission, improve quality of life and have been demonstrated to be a cost-effective public health intervention. However, in 2012 47% of new HIV diagnoses were late diagnoses, and 22% of the 98 400 people living with HIV in the UK remained undiagnosed. This is despite recommendations from the National Institute for Clinical Excellence (NICE) Public Health Committee and the UK's National HIV Testing guidelines that all patients accessing secondary care or those having planned venepuncture should be tested for HIV if the diagnosed prevalence of HIV exceeds 2 per 1000.
Low rates of HIV testing have been repeatedly demonstrated in hospital settings in the UK, even in those patients presenting with clinical indicators for HIV infection. The emergency department (ED) is a desirable target for HIV testing within hospitals as it serves a high-throughput population of diverse attendees. However, the focus on trauma and resuscitation as well as the 4-hour wait make it, understandably, logistically difficult to prioritize HIV testing initiatives. Our ED serves a population with a very high diagnosed prevalence of HIV (6 1000 population) - three times higher than the prevalence at which testing is routinely recommended. The busy ED is home to London's air ambulance and has 400 000 attendances per year.