Emergency Departments Can Play Critical Role in HIV Detection in Low-Resource Settings

Emergency departments (EDs) can play a critical role in the identification of undiagnosed HIV in low-resource areas, according to study results published in PLOS ONE.

Early detection of HIV is critical to improving quality of life outcomes for patients, achieving viral suppression, and reducing HIV transmissions. South Africa has the largest HIV epidemic in the world, accounting for 19% of people living with HIV, 15% of new infections, and 11% of AIDS-related deaths. Despite the 2015 National South African HIV testing guidelines mandating universal testing in all healthcare facilities, ED-based HIV testing is not routinely implemented. Researchers from Johns Hopkins observed a South African ED to determine the burden of undiagnosed HIV and the effectiveness of HIV testing in the setting.

“As a region, the Eastern Cape has one of the highest rates of HIV infection in the world,” said Thomas Quinn, MD, professor of medicine, Johns Hopkins University School of Medicine and senior author of the study, in a statement. “This particular study is the first to document the full magnitude of HIV infection in the region, and the eagerness of the people to know whether they are infected with HIV.”

The group implemented the nationally recommended counselor-initiated point-of-care HIV counseling and testing (HCT) program. All patients in the ED who were clinically stable and fully conscious were eligible to be approached by HCT staff to receive a rapid point-of-care HIV test.

From September 1 to November 30, 2016, 2355 patients were approached by HCT staff, of which 1714 (72.8%) accepted HIV testing. For those who declined testing, 138 (27.4%) stated they had a known diagnosis of HIV. Of the 1714 tests performed, 262 were positive, and 1452 were negative. Of the HIV-positive patients, 115 stated this was a new diagnosis.

As part of the research, the researchers educated staff at the hospital on the importance of the study and HIV testing, trained them to approach patients, and administer testing and assist in recording findings, according to a press release from Johns Hopkins School of Medicine.

Despite HCT staff providing services 24 hours a day, counselors were only able to approach 1 in 4 patients who came into the ED because of the time-consuming nature of the HIV testing process. “Further innovation, such as HIV patient self-testing, and implementation research is necessary to develop a sustainable testing strategy for the clinical environment so that service delivery in the ED can be improved,” said the authors in a statement.

Reference:

Hansoti B, Stead D, Parrish A, et al. HIV testing in a South African emergency department: A missed opportunity. [published online March 13]. PLoS ONE. doi.org/10.1371/journal.pone.0193858.