When is emergency department (ED) rapid HIV testing performed?

Updated: Feb 04, 2019
  • Author: Jacob D Isserman, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Answer

Outreach programs can provide rapid HIV testing in the community. Counseling and testing can be completed anywhere, including in patients' homes. These programs provide an opportunity to identify high-risk patients who otherwise would not seek outpatient testing. Emergency department (ED) testing has the following features:

  • Routine HIV screening of asymptomatic patients and outpatient referral for confirmatory testing and care (routine opt-out screening of ED patients may result in increased numbers of patients tested and identified as HIV positive compared to physician-directed screening [6] )
  • Identification of acute HIV infection with possible ED diagnosis and/or referral for further diagnostics and treatment
  • Confirmation of diagnosis of HIV in patients with AIDS-defining illness, previously not known to be seropositive
  • There are multiple models of HIV screening in the ED. “Opt out” programs, as recommended by the CDC, have the potential to screen the greatest number of patients compared to “opt in” programs, but may be hindered by state laws governing consent to testing and refusal of testing and burden the ED with increased costs of testing. [7] Having a dedicated counselor screen for HIV has been shown to be significantly more successful than provider-based screening; however, there is an added cost to a counselor-based testing program. [8]  Replacing counselors with trained ED technicians has been shown to increase rates of testing. [9] In addition, some sites have found success with novel self-testing kiosks. [10]

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