Detecting Unsuspected HIV Infection With a Rapid Whole-Blood HIV Test in an Urban Emergency Department

OBJECTIVE: To evaluate and compare HIV screening and provider-referred diagnostic testing as strategies for detecting undiagnosed HIV infection in an urban emergency department (ED). METHODS: From January 2003 through April 2004, study staff offered HIV screening with rapid tests to ED patients regardless of risks or symptoms. ED providers could also refer patients for diagnostic testing. Patients aged 18 to 54 years without known HIV infection were eligible. RESULTS: Of 4849 eligible patients approached for screening, 2824 (58%) accepted and were tested; 414 (95%) of 436 provider-referred patients accepted and were tested. Thirty-five (1.2%) screened patients and 48 (11.6%) provider-referred patients were infected with HIV (P < 0.001). Of these, 18 (51%) screened patients and 24 (50%) referred patients reported no traditional risk factors; 27 (77%) screened patients and 38 (79%) referred patients entered HIV care. Of HIV-infected patients with CD4 cell counts available, 14 (45%) of 31 screened patients and 37 (82%) of 45 provider-referred patients had <200 cells/microL (P < 0.001). CONCLUSIONS: ED screening detects HIV infection and links to care patients who may not be tested through risk- or symptom-based strategies. The diagnostic yield was higher among provider-referred patients, but screening detected patients earlier in the course of disease.