Laboratory (non-rapid) HIV testing in the emergency department: Methods, outcomes, and effectiveness
Abstract
- There is a large body of evidence examining best practices, outcomes, impact, and other aspects of laboratory (non-rapid) HIV testing in emergency departments (EDs).
- Many studies have identified missed opportunities for HIV testing in the ED. The literature recognizes a need to streamline the process of obtaining informed consent and ordering HIV tests in ED settings and to provide patients with concurrent HIV testing along with testing for sexually transmitted infections (STIs).
- Methodologies across EDs that conducted laboratory (non-rapid) HIV testing included: testing only individuals that were having other bloodwork conducted, integrating testing into the current medical flow of the ED, screening individuals for HIV testing during triage, incorporating processes that made ordering HIV tests akin to other diagnostic tests, using the hospital’s electronic medical record system to assist with testing processes, and collaborating with the hospital’s infectious disease clinic to link individuals with HIV-positive test results to care.
- Common outcomes examined included: the proportion of eligible patients offered testing that consented, the prevalence of new and previously known HIV diagnoses detected, and the proportion of diagnosed individuals linked to care.
- Studies found laboratory HIV testing in the ED to be both feasible and acceptable.
- Studies in the U.S. have demonstrated instances where laboratory blood-based HIV testing in the ED cost less than rapid HIV testing. In terms of cost-effectiveness, a 2018 report identified three studies that used laboratory HIV testing in the ED which identified HIV cases above the cost-effectiveness threshold of 0.1%. A 2017 Dutch study found that routine, blood-based HIV testing in the ED was not cost-effective, although the study used a low incremental cost effectiveness ratio of EUR 20,000.
Authors
The Ontario HIV Treatment Network: Rapid Response Service
Year
2021
Topics
- Population(s)
- General HIV+ population
- General HIV- population
- Testing
- Testing
- Health Systems
- Delivery arrangements
