Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021 Jul 1;4(7):e2117763.
doi: 10.1001/jamanetworkopen.2021.17763.

Comparison of HIV Screening Strategies in the Emergency Department: A Randomized Clinical Trial

Jason S Haukoos  1   2   3 , Michael S Lyons  4 , Richard E Rothman  5 , Douglas A E White  6 , Emily Hopkins  1   2 , Meggan Bucossi  1   2 , Andrew H Ruffner  4 , Rachel M Ancona  4 , Yu-Hsiang Hsieh  5 , Stephen C Peterson  5 , Danielle Signer  5 , Matthew F Toerper  5 , Mustapha Saheed  5 , Sarah K Pfeil  6 , Tamara Todorovic  6 , Alia A Al-Tayyib  3   7 , Lucy Bradley-Springer  8 , Jonathan D Campbell  9 , Edward M Gardner  7   8 , Sarah E Rowan  7   8 , Allison L Sabel  10   11 , Mark W Thrun  7   8   12 ; HIV TESTED Trial Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Comparison of HIV Screening Strategies in the Emergency Department: A Randomized Clinical Trial

Jason S Haukoos et al. JAMA Netw Open. .

Abstract

Importance: The National HIV Strategic Plan for the US recommends HIV screening in emergency departments (EDs). The most effective approach to ED-based HIV screening remains unknown.

Objective: To compare strategies for HIV screening when integrated into usual ED practice.

Design, setting, and participants: This randomized clinical trial included patients visiting EDs at 4 US urban hospitals between April 2014 and January 2016. Patients included were ages 16 years or older, not critically ill or mentally altered, not known to have an HIV positive status, and with an anticipated length of stay 30 minutes or longer. Data were analyzed through March 2021.

Interventions: Consecutive patients underwent concealed randomization to either nontargeted screening, enhanced targeted screening using a quantitative HIV risk prediction tool, or traditional targeted screening as adapted from the Centers for Disease Control and Prevention. Screening was integrated into clinical practice using opt-out consent and fourth-generation antigen-antibody assays.

Main outcomes and measures: New HIV diagnoses using intention-to-treat analysis, absolute differences, and risk ratios (RRs).

Results: A total of 76 561 patient visits were randomized; median (interquartile range) age was 40 (28-54) years, 34 807 patients (51.2%) were women, and 26 776 (39.4%) were Black, 22 131 (32.6%) non-Hispanic White, and 14 542 (21.4%) Hispanic. A total of 25 469 were randomized to nontargeted screening; 25 453, enhanced targeted screening; and 25 639, traditional targeted screening. Of the nontargeted group, 6744 participants (26.5%) completed testing and 10 (0.15%) were newly diagnosed; of the enhanced targeted group, 13 883 participants (54.5%) met risk criteria, 4488 (32.3%) completed testing, and 7 (0.16%) were newly diagnosed; and of the traditional targeted group, 7099 participants (27.7%) met risk criteria, 3173 (44.7%) completed testing, and 7 (0.22%) were newly diagnosed. When compared with nontargeted screening, targeted strategies were not associated with a higher rate of new diagnoses (enhanced targeted and traditional targeted combined: difference, -0.01%; 95% CI, -0.04% to 0.02%; RR, 0.7; 95% CI, 0.30 to 1.56; P = .38; and enhanced targeted only: difference, -0.01%; 95% CI, -0.04% to 0.02%; RR, 0.70; 95% CI, 0.27 to 1.84; P = .47).

Conclusions and relevance: Targeted HIV screening was not superior to nontargeted HIV screening in the ED. Nontargeted screening resulted in significantly more tests performed, although all strategies identified relatively low numbers of new HIV diagnoses.

Trial registration: ClinicalTrials.gov Identifier: NCT01781949.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Haukoos reported receiving grant funding from the National Institute on Drug Abuse (NIDA) (No. R01DA042982) and the Agency for Healthcare Research and Quality (AHRQ) (No. K02HS017526 and R01HS021749) during the conduct of this study. Dr Lyons reported receiving grant funding from NIDA (R01DA049282), AHRQ (No. R01HS021749), the Cincinnati Health Network, and Hamilton County Public Health during the conduct of this work, and from Gilead Sciences, Inc outside the submitted work. Dr Rothman reported receiving grant funding from the National Institute on Drug Abuse (No. R01DA049282), AHRQ (No. R01HS021749), Gilead Sciences, Inc, and the Maryland Department of Health and Mental Hygiene during the conduct of the study. Dr White reported receiving grant funding from the National Institute on Drug Abuse (No. R01DA049282) during the conduct of this study, and from Gilead Sciences, Inc outside the submitted work. Dr Ancona reported receiving research support from Gilead Sciences outside the submitted work. Dr Pfeil reported receiving research funding from Gilead Sciences, Inc during the conduct of the study. Dr Al-Tayyib reported receiving grant funding from Denver Health during the conduct of the study. Dr Campbell reported receiving grant funding from Denver Health during the conduct of the study. Dr Rowan reported receiving grant funding from Gilead Sciences outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Flow Diagram
Enrollment occurred from April 8, 2014, through January 27, 2016, with longitudinal follow-up through January 27, 2017. Patients considered high risk for enhanced targeted screening had a Denver HIV Risk Score of 30 or higher; for traditional targeted screening, eligible patients had at least 1 risk behavior as adapted from the Centers for Disease Control and Prevention.
Figure 2.
Figure 2.. Distribution of Patient Visits and HIV Diagnoses Within Targeted Screening Arms
BRST indicates Behavioral Risk Screening Tool; DHRS, Denver HIV risk score.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention . Ending the HIV Epidemic: A Plan for America. Published July 30, 2020. Accessed April 1, 2021. https://www.cdc.gov/endhiv/docs/ending-HIV-epidemic-overview-508.pdf
    1. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793-800. doi:10.1093/cid/ciq243 - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention . HIV Basic Statistics. Published July 1, 2020. Accessed April 1, 2021. https://www.cdc.gov/hiv/basics/statistics.html
    1. Branson BM, Handsfield HH, Lampe MA, et al. ; Centers for Disease Control and Prevention . Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55(RR-14):1-17. - PubMed
    1. Moyer VA; US Preventive Services Task Force . Screening for HIV: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(1):51-60. doi:10.7326/0003-4819-159-1-201307020-00645 - DOI - PubMed

Publication types

Associated data