CLINICAL SCIENCE Routine HIV Screening in the Emergency Department Using the New US Centers for Disease Control and Prevention Guidelines Results From a High-Prevalence Area

Prevention (CDC) released new recommendations for routine HIV testing. Among these were recommendations that emergency depart-ments (EDs) offer routine opt-out HIV screening to their patients. We established a screening program implementing these recommen-dations at an urban university hospital ED in Washington, DC. We report the results of this program. Methods: During a 3-month period, ED patients being treated for a wide range of conditions were approached by trained HIV screeners and offered point-of-care rapid HIV testing. Patients with positive results were referred to hospital or community resources for con-firmatory testing and treatment. Results: During the program period, 14,986 patients were treated in the ED and 4151 (27.6%) were offered HIV screening. The mean patient age was 37.5 years; 48.5 % were black, 39.0 % were non-Hispanic white, 4.1 % were Hispanic, 1.7 % were Asian, and 6.7% responded as being other race. A total of 56.1 % were female, and most lived within the Washington, DC metropolitan area. Of the patients offered HIV screening, 2476 (59.7%) accepted the test. Of the 26 patients with a preliminary positive screen, 13 were lost to follow-up, 9 were confirmed positive by Western blot, and 4 were confirmed negative by Western blot. Eight of the 9 patients with confirmed HIV infection were successfully linked to follow-up care. Conclusions: The implementation of the CDC recommenda-tions establishing routine opt-out HIV screening programs in EDs is feasible. Further efforts to establish routine ED HIV testing are therefore warranted