Using the new and highly publicized CDC guidelines for HIV screening, a university-based Emergency Department implemented opt-out screening in Washington, DC, where HIV infection rates are known to be high. Fully 60% of the patients agreed to the testing, a high percentage that may have been influenced by an ongoing district-wide campaign encouraging HIV screening. Over 4000 patients were eligible for the free screening and almost 2500 were tested, with 26 patients (1%) having a preliminary positive result.
Rapid screening kits were provided free of charge by the DC Department of Health and researchers were enlisted to conduct the clinical activities. As such, this effort would not be sustainable over time, but the author will suggest some models for ongoing program implementation.
The study resulted in a cost per preliminary positive of approximately $1,700, and a cost of $4,900 per confirmed case of HIV infection. According to study author Jeremy Brown, MD, Research Director, Department of Emergency Medicine, George Washington University Medical School, "Washington, DC has one of the highest AIDS case prevalence rates in the United States and our results suggest that ED HIV screening in this high prevalence area is well accepted by patients. The cost per case detected is low when compared with other methods for the early detection of HIV. For example nucleic acid amplification has been used to detect early detection of HIV infection at a cost of over $17,000 per index case identified."
The presentation is entitled "Opt- Out HIV Testing in the Emergency Department: Results From A High Prevalence Setting Following the New CDC Guidelines" by Jeremy Brown, MD. This paper will be presented at the 2007 Society for Academic Emergency Medicine (SAEM) Annual Meeting, May 16-19, 2007, Chicago, IL on Wednesday, May 16th, in the HIV Testing session beginning at 3:30 in room Michigan B of the Sheraton Chicago Hotel & Towers. Abstracts of the papers presented are published in Volume 14, Issue 5S, the May 2007 supplement of the official journal of the SAEM, Academic Emergency Medicine.