Universal HIV and Birth Cohort HCV Screening in San Diego Emergency Departments

Martin Hoenigl,Sharon L Reed,Susan J Little,Gabriel A Wagner,Christopher J Coyne,Gary M Vilke,Melanie Mccauley,Lucy E Horton,Miriam Zuazo,Jesse Brennan,Kushagra Mathur,Jill Blumenthal

doi:10.1038/s41598-019-51128-6

Martin Hoenigl, Sharon L Reed + Show 10 more

Open Access

https://doi.org/10.1038/s41598-019-51128-6

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Abstract

Universal HIV and HCV screening in emergency departments (ED) can reach populations who are less likely to get tested otherwise. The objective of this analysis was to evaluate universal opt-out HIV and HCV screening in two EDs in San Diego. HIV screening for persons aged 13–64 years (excluding persons known to be HIV+ or reporting HIV testing within last 12 months) was implemented using a 4th generation HIV antigen/antibody assay; HCV screening was offered to persons born between 1945 and 1965. Over a period of 16 months, 12,575 individuals were tested for HIV, resulting in 33 (0.26%) new HIV diagnoses, of whom 30 (90%) were successfully linked to care. Universal screening also identified 74 out-of-care for >12-months HIV+ individuals of whom 50 (68%) were successfully relinked to care. Over a one-month period, HCV antibody tests were conducted in 905 individuals with a seropositivity rate of 9.9% (90/905); 61 seropositives who were newly identified or never treated for HCV had HCV RNA testing, of which 31 (51%) resulted positive (3.4% of all participants, including 18 newly identified RNA positives representing 2% of all participants), and 13/31 individuals (42%) were linked to care. The rate of newly diagnosed HCV infections exceeded the rate of newly diagnosed HIV infections by >7-fold, underlining the importance of HCV screening in EDs.

Highlights

40,000 individuals in the United States were newly diagnosed with HIV in 20171
HIV testing increased significantly once the opt-out discussion was moved from the nursing triage process to the bedside at the time of the blood draw, which resulted in a drop in the opt-out rate from 37% to about 5% (Fig. 2, see Methods section)
We successfully instituted universal opt-out HIV and a pilot birth-cohort-targeted hepatitis C virus (HCV) screening in two emergency department (ED) in San Diego

Summary

Introduction

40,000 individuals in the United States were newly diagnosed with HIV in 20171. Targeted testing of those engaged in transmission risk behaviors, such as sexually active men who have sex with men (MSM) and people who inject drugs results in a higher yield of HIV diagnoses[3,4,5,6], universal (i.e. opt-out) HIV screening in emergency department (ED) settings has the potential to reach populations who do not consider themselves at risk or are otherwise less likely to seek out and participate in HIV testing[7,8]. The CDC recommends routine HCV screening for this birth cohort, due to the high frequency of illicit drug use and contaminated transfusions that occurred in the 1970s and 80s14 The objectives of this analysis were to evaluate universal opt-out HIV and birth-cohort HCV screening and determine the number of known HIV-positive individuals out of care identified through the program at two academic emergency departments in San Diego, California

Methods

Results

Conclusion