Universal HIV and Birth Cohort HCV Screening in San Diego Emergency Departments

Abstract

Universal HIV and HCV screening in emergency departments (ED) can reach populations who are less likely to get tested otherwise. The objective of this analysis was to evaluate universal opt-out HIV and HCV screening in two EDs in San Diego. HIV screening for persons aged 13-64 years (excluding persons known to be HIV+ or reporting HIV testing within last 12 months) was implemented using a 4^th generation HIV antigen/antibody assay; HCV screening was offered to persons born between 1945 and 1965. Over a period of 16 months, 12,575 individuals were tested for HIV, resulting in 33 (0.26%) new HIV diagnoses, of whom 30 (90%) were successfully linked to care. Universal screening also identified 74 out-of-care for >12-months HIV+ individuals of whom 50 (68%) were successfully relinked to care. Over a one-month period, HCV antibody tests were conducted in 905 individuals with a seropositivity rate of 9.9% (90/905); 61 seropositives who were newly identified or never treated for HCV had HCV RNA testing, of which 31 (51%) resulted positive (3.4% of all participants, including 18 newly identified RNA positives representing 2% of all participants), and 13/31 individuals (42%) were linked to care. The rate of newly diagnosed HCV infections exceeded the rate of newly diagnosed HIV infections by >7-fold, underlining the importance of HCV screening in EDs.

Figure 1

Flow diagram of testing algorithm (blue) and Case Management flow (brown). New HIV positives were identified only via testing, while known HIV positives were identified via testing and also question 1 of the automated EMR algorithm.

Figure 2

Number of HIV tests per week (number of tests Y-axis, week on X-axis) in the two participating Emergency Departments. Blue rectangle indicates the time period the HCV pilot was conducted. Arrow indicates the time when the opting-out discussion was moved from the nursing triage to the blood draw.