Routine HIV testing within the emergency department of a major trauma centre: a pilot study

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.

Keywords: HIV testing; emergency department; late diagnosis; routine.