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Referral of ED patients to outpatient HIV testing is not an effective way to identify unrecognized HIV infection

Estimated rates of HIV infection among emergency department (ED) patients range from 0 to 14 percent, with inner-city EDs most likely to treat patients with unrecognized HIV infection. The Centers for Disease Control and Prevention recommends testing all individuals in settings where the HIV prevalence is 1 percent or more. CDC also recommends that HIV counseling be part of the testing, which is often impractical in the ED setting.

As a result, emergency physicians usually refer patients suspected of being infected with, or at risk for HIV to an outpatient HIV counseling and testing center. However, since few ED patients show up at the clinics, this referral system is ineffective at identifying unrecognized HIV infection, according to a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award fellowship F32 HS11509).

Jason S. Haukoos, M.D., M.S., of the University of California, Los Angeles, and his colleagues examined the ED records and HIV clinic records, if applicable, of patients referred for outpatient HIV testing from an urban hospital ED. Of the 494 patients referred from the ED, only 11 percent arrived at the HIV clinic and completed pretest counseling. Of these, 91 percent tested negative for HIV, 7 percent tested positive for HIV, and 2 percent refused the test. The researchers suggest that changes in the structure of the referral system or the use of point-of-care testing in the ED may improve the ability to detect HIV infection among ED patients.

See "Evaluation of an emergency department referral system for outpatient HIV testing," by Clinton J. Coil, M.D., M.P.H., Dr. Haukoos, Mallory D. Witt, M.D., and others, in the January 1, 2004, Journal of Acquired Immune Deficiency Syndrome 35(1), pp. 52-55.

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