Estimation of the prevalence of undiagnosed and diagnosed HIV in an urban emergency department.

William M Reichmann,Rochelle P Walensky,Jeffrey N Katz,Elena Losina,Christian Arbelaez,Anna Novais,Amy Case

doi:10.1371/journal.pone.0027701

Abstract

ObjectiveTo estimate the prevalence of undiagnosed HIV, the prevalence of diagnosed HIV, and proportion of HIV that is undiagnosed in populations with similar demographics as the Universal Screening for HIV in the Emergency Room (USHER) Trial and the Brigham and Women's Hospital (BWH) Emergency Department (ED) in Boston, MA. We also sought to estimate these quantities within demographic and risk behavior subgroups.MethodWe used data from the USHER Trial, which was a randomized clinical trial of HIV screening conducted in the BWH ED. Since eligible participants were HIV-free at time of enrollment, we were able to calculate the prevalence of undiagnosed HIV. We used data from the Massachusetts Department of Public Health (MA/DPH) to estimate the prevalence of diagnosed HIV since the MA/DPH records the number of persons within MA who are HIV-positive. We calculated the proportion of HIV that is undiagnosed using these estimates of the prevalence of undiagnosed and diagnosed HIV. Estimates were stratified by age, sex, race/ethnicity, history of testing, and risk behaviors.ResultsThe overall expected prevalence of diagnosed HIV in a population similar to those presenting to the BWH ED was 0.71% (95% CI: 0.63%, 0.78%). The prevalence of undiagnosed HIV was estimated at 0.22% (95% CI: 0.10%, 0.42%) and resultant overall prevalence was 0.93%. The proportion of HIV-infection that is undiagnosed in this ED-based setting was estimated to be 23.7% (95% CI: 11.6%, 34.9%) of total HIV-infections.ConclusionsDespite different methodology, our estimate of the proportion of HIV that is undiagnosed in an ED-setting was similar to previous estimates based on national surveillance data. Universal routine testing programs in EDs should use these data to help plan their yield of HIV detection.

Highlights

Among academic Emergency Departments (EDs) surveyed between December 2006 and March 2007, 13% (13/102) had instituted routine HIV screening policies in response to the 2006 Centers for Disease Control and Prevention (CDC) revised guidelines [1,2]
The prevalence of undiagnosed HIV was estimated at 0.22% and resultant overall prevalence was 0.93%
We found that the proportion missing data for history of testing was similar for those tested in the USHER Trial (36%) compared to those who were not tested in the USHER Trial (39%)

Summary

Introduction

Among academic Emergency Departments (EDs) surveyed between December 2006 and March 2007, 13% (13/102) had instituted routine HIV screening policies in response to the 2006 Centers for Disease Control and Prevention (CDC) revised guidelines [1,2]. The estimated proportion of HIV infection that remains undiagnosed in the United States decreased from 25% in 2000 [3] to 21% in 2006 [4] and to 20% in 2008 [5]. As universal HIV screening becomes more frequently implemented and the prevalence of undiagnosed HIV becomes less common, the proportion of HIV that is undiagnosed decreases. Older ED studies (1987–1990) throughout the nation have reported much higher estimates for the percentage of HIV that is undiagnosed, ranging from 49%–77% [6,7,8,9,10]. Studies from the mid-1990 s reported estimates of the percentage of HIV that is undiagnosed to be in line with more current CDC estimates in the US (range 20–28%) [11,12,13]. The most recent study, which was conducted by Clauss and colleagues in 2007, estimated that the proportion of HIV that was undiagnosed was 28.9% [14]

Methods

Results

Conclusion