Abstract
BackgroundIn Switzerland, the national HIV testing recommendations propose targeted testing. Although the emergency department (ED) is mentioned specifically as a site where HIV testing should take place, the testing rate in our ED is 1% of patients seen. The aim of this study was to use electronic tablets to offer testing to ED patients and to examine whether non-targeted screening increased testing rates compared to targeted testing.MethodsThis randomised, cross-over design study took place at Lausanne University Hospital, Switzerland, between August and November 2015. Eligible patients were randomised to a targeted testing or a non-targeted screening arm. Using electronic tablets, targeted arm patients completed a risk factor assessment; patients with risk factors were offered free rapid HIV testing. Non-targeted arm patients received information about HIV and HIV testing on their tablet and were then offered testing. In a second step, patients who declined testing were crossed over to the other strategy. The primary endpoint was the HIV testing rate per arm.ResultsEighty patients were recruited to each study arm. In the targeted arm, 17 patients (of 80, 21%) had at least one risk factor and were offered testing, of whom eight (of 17, 47%) accepted. HIV testing rate in the targeted arm was 10% (8/80) compared to 48% (38/80) in the non-targeted arm (P<0.001). Secondary cross–screening, where targeted arm patients without risk factors were offered non-targeted screening, increased the testing rate in the targeted arm to 45% (36/80). Among patients offered testing, the acceptance rate did not differ between targeted and non-targeted arms, at 48% and 53%, respectively (P = 0.9)DiscussionIn our centre, non-targeted HIV screening resulted in a higher testing rate than targeted testing due to more patients being offered a test. The acceptance rate of testing offered did not differ between targeted and non-targeted arms. Electronic tablets were well-received by patients and easy to use. We conclude that non-targeted HIV screening using electronic tablets would increase the HIV testing rate in our ED.Trial registrationClinicalTrials.gov NCT03038724
Highlights
In Switzerland, between 13,000 and 29,000 people are living with HIV [1,2,3], of whom an estimated 20% is unaware of being infected [3]
Non-targeted HIV screening resulted in a higher testing rate than targeted testing due to more patients being offered a test
Electronic tablets were well-received by patients and easy to use
Summary
In Switzerland, between 13,000 and 29,000 people are living with HIV [1,2,3], of whom an estimated 20% is unaware of being infected [3]. To address undiagnosed HIV infection, the Swiss Federal Office of Public Health (FOPH) has published HIV testing recommendations since 2007 which propose targeted testing [4]. In 2010, the Emergency Department (ED) was mentioned by the FOPH as a site where HIV testing should occur [5]. This is justified by the high number of patients using this service (in Switzerland in 2011, this was 1.6 million visits or 20.4 per 100 inhabitants [7]) and by ED patient demography, many individuals being vulnerable and at risk of HIV acquisition. The aim of this study was to use electronic tablets to offer testing to ED patients and to examine whether non-targeted screening increased testing rates compared to targeted testing
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