Abstract
ObjectiveIn October 2009 the French National Authority for Health recommended that HIV testing be proposed at least once to all persons aged 15 to 70 years in all healthcare settings. We examined whether routine HIV screening with a rapid test in emergency departments (EDs) was feasible without dedicated staff, and whether newly diagnosed persons could be linked to care.MethodsThis one-year study started in December 2009 in 6 EDs in the Paris area, using the INSTI™ test. Eligible individuals were persons 18 to 70 years old who did not present for a vital emergency, for blood or sexual HIV exposure, or for HIV screening. Written informed consent was required.ResultsAmong 183 957 eligible persons, 11 401 were offered HIV testing (6.2%), of whom 7936 accepted (69.6%) and 7215 (90.9%) were tested (overall screening rate 3.9%); 1857 non eligible persons were also tested. Fifty-five new diagnoses of HIV infection were confirmed by Western blot (0.61% (95% CI 0.46–0.79). There was one false-positive rapid test result. Among the newly diagnosed persons, 48 (87%) were linked to care, of whom 36 were not lost to follow-up at month 6 (75%); median CD4 cell count was 241/mm3 (IQR: 52–423/mm3).ConclusionsScreening rates were similar to those reported in opt-in studies with no dedicated staff. The rate of new diagnoses was similar to that observed in free anonymous test centres in the Paris area, and well above the prevalence (0.1%) at which testing has been shown to be cost-effective.
Highlights
In most industrialized countries about one-third of HIVinfected patients access the health care system with advanced HIV disease (CD4 cell count below 200/mm2 or AIDS), and onehalf late (CD4 cell count below 350/mm3 or AIDS) [1,2,3,4]
Several studies have shown that expanded screening is cost-effective if the prevalence of undiagnosed HIV infection is above 0.1% [8,9]
In France, the National Authority for Health issued new guidelines on HIV screening in 2009: systematic HIV screening was to be proposed at least once to all people aged from 15 to 70 years, regardless of signs or symptoms, and whatever the risk profile, in addition to targeted HIV screening every year for men who have sex with men (MSM), intravenous drug users (IDUs), and heterosexuals from sub-Saharan Africa and the Caribbean region who have multiple partners
Summary
In most industrialized countries about one-third of HIVinfected patients access the health care system with advanced HIV disease (CD4 cell count below 200/mm or AIDS), and onehalf late (CD4 cell count below 350/mm or AIDS) [1,2,3,4]. Several studies have shown that expanded screening is cost-effective if the prevalence of undiagnosed HIV infection is above 0.1% [8,9]. In France, the National Authority for Health issued new guidelines on HIV screening in 2009: systematic HIV screening was to be proposed at least once to all people aged from 15 to 70 years, regardless of signs or symptoms, and whatever the risk profile, in addition to targeted HIV screening every year for men who have sex with men (MSM), intravenous drug users (IDUs), and heterosexuals from sub-Saharan Africa and the Caribbean region who have multiple partners. The Paris area is one of the most affected regions of France, accounting for 44% of new diagnoses [14], and with an estimated prevalence of undiagnosed infection slightly above 0.1%
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