Idealized Models or Incremental Program Evaluation: Translating Emergency Department HIV Testing Into Practice

Abstract

As the human immunodeficiency virus (HIV) epidemic in the United States continues, it is estimated that over 1 million individuals are infected, and approximately 250,000 remain undiagnosed.1 Last year, the estimate of incidence was revised upward to approximately 56,000 new HIV infections annually.2 Past prevention efforts have been incompletely effective, and screening is increasingly recognized as a powerful prevention intervention.3, 4 Accordingly, in 2006 the Centers for Disease Control and Prevention (CDC) revised their recommendations for performing HIV testing in health care settings with significant focus on emergency departments (EDs).4 These recommendations called for performing nontargeted, opt-out, rapid HIV screening as an integrated part of medical care for all patients aged 13 to 64 years in clinical settings where the estimated prevalence was 0.1% or higher. To overcome barriers to HIV screening, the CDC also recommended integrating consent for HIV testing into the general medical consent process and uncoupling prevention counseling from testing. This multifaceted approach represents a dramatic paradigm shift and offers the promise of significantly changing the HIV testing landscape if it can be implemented in a widespread fashion.