The study alternated the two testing methods during a series of 4-month intervals from April 2007 through April 2009 in the emergency department at Denver Health Medical Center, a 477-bed urban public safety-net hospital, with about 55,000 emergency visits a year.
During the routine screening phase, 28,043 eligible patients presented to the emergency department; 6,702 agreed to be screened. Of these patients, 10 (0.15%) had a new diagnosis of HIV infection because of screening, Dr. Jason S. Haukoos said at the briefing. Among the more than 21,000 emergency patients who opted out of screening, examining physicians identified 231 people for HIV testing, which identified 5 new cases (2.2%). During the diagnostic phase, emergency physicians identified 243 people to test out of 29,925 people who passed through the department clinic. Testing of these 243 identified 4 new cases (1.6%). Simultaneous with his report, the results were published online (JAMA 2010;304:284-92).
Physician-directed diagnostic testing “is the standard of care for most emergency departments in the United States,” said Dr. Haukoos, director of research for the department of emergency medicine at Denver Health. “The results of our study show that opt-out screening is challenging, labor-intensive, and costly. We'd be hard pressed to do it in all U.S. emergency departments.
“These are the first comparative results for opt-out screening” for HIV, he said in an interview. “We probably need a simpler approach” that involves layering some form of targeted screening on top of physician-directed diagnostic testing.
An editorial that accompanied the Denver report noted that the current CDC screening recommendations “might not be the optimal methods for all settings.” Dr. Roland C. Merchant and Dr. Michael J. Waxman, both from Brown University, Providence, R.I., wrote that the “next greatest challenge will be to identify which HIV screening models are most effective and efficient and can be self-sustaining after research funding has been removed” (JAMA 2010;304:348-9).
Dr. Haukoos agreed. “The current model for screening is not sustainable. Who will pay for screening outside of a research project?”
Disclosures: Dr. Thompson said she has received support from or served in an advisory capacity for Abbott, Avexa, Boehringer Ingelheim, Bristol-Myers Squibb, Chimerix, GlaxoSmithKline, Gilead, GeoVax, Katketsuken, Koronis, Merck, Myriad, Ora-Sure, Panacos, Pfizer, Progenics, Roche, Roche Molecular, Serono, Theratechnologies, Tibotec, Tobira, Trimeris, and VaxGen. Dr. Haukoos said that he has received research support from Abbott.
Elsevier Global Medical News