Characterization of new HIV diagnoses made in hospital emergency departments through the "Leave Your Mark" program

Abstract

Introduction: The Leave Your Mark (DTH) program launched recommendations for HIV screening in emergency departments (ED) when patients presented with certain conditions. It is unknown whether the profile of patients diagnosed in the ED is similar to those reported for general population in epidemiological reports.

Methods: Retrospective study evaluating the characteristics of patients with new HIV diagnosed in 17 ED over a one-year period was developed. Demographic data (sex at birth, age, country of birth), sexual and risk behaviour, diagnosis in ED, number of emergency visits in previous five years, time from the ED to the specific HIV consultation, and from ED to start antiretroviral treatment were recorded. Information on the first CD4 and viral load was also collected.

Results: A total of 169 patients were included. There were 122 (72.2%) migrants, 57 (32.5%) heterosexual, and injection drug use was the transmission route in 14 (8.3%) cases. Data reported for the general population were 49.8%, 25.7%, and 1.7%, respectively. Late diagnosis was found in 80 (47.3%) patients (reported figures by the Ministry, 48.7%). Compared to Spanish, migrant were more frequently women (13.1% vs. 6.4%), heterosexual (38.5% vs. 21.3%), and had worse immunological status [median CD4 count of 310 (IQR 132-457) vs. 444 (IQR 215-607)].

Conclusion: ED can play a key role in diagnosing a different patient profile that may not seek care at other healthcare levels.

Keywords: Diagnóstico precoz; Early diagnosis; Emergency department; HIV infection; Human immunodeficiency virus (HIV); Infección por VIH; Servicios de urgencias; Virus de la inmunodeficiencia humana (VIH).