HIV testing in ED serves as link to care
SEATTLE — An HIV testing program in an ED, which was originally implemented to describe the local epidemic, played a significant role in linking individuals to care, according to data presented at CROI 2015.
“Over a 25-year period, the program evolved, and this change is partially evidenced by declining undiagnosed HIV infection, increased use of antiretroviral therapy, increased viral suppression and decline in HIV incidence,” Thomas C. Quinn, MD, of the National Institute of Allergy and Infectious Diseases, said during his presentation.
Quinn and colleagues examined local trends in HIV and hepatitis C in the Johns Hopkins Hospital ED population for a 25-year period. They conducted 6- to 8-week identity-unlinked serosurveys in the ED in 1987, 1988, 1992, 2001, 2007 and 2013. The study included 18,144 eligible patients who required a blood draw for a medical reason. Excess sera were collected, and specimens underwent ELISA testing followed by Western blot (from 1992-2013). The specimens also were tested for HCV in 1988 and from 2001 to 2013.
The prevalence of HIV was approximately 5% in 1987 and increased to about 11% in 1993. After remaining at 11% for about 10 years, the prevalence declined to 8% in 2007 and then to 6% in 2013. The proportion of undiagnosed HIV infections was 77% in 1987, but declined to 28% in 1992 and to 12% in 2013.
From 2001 to 2013, the researchers measured viral load, and they tested for presence of ART drugs from 2007 to 2013. In 2001, 23% of HIV-positive individuals had viral suppression, which increased to 59% in 2013. Similarly, 80% of HIV-positive individuals in 2013 had ART drugs in their sera, compared with 27% in 2007.
HCV prevalence was observed to be between 18% and 19% from 1988 to 2007, and declined to about 14% in 2013. The prevalence of HIV/HCV coinfection remained stable, ranging from 48% to 52%, from 2007 to 2013.
“EDs serve as primary health care facilities for millions of individuals,” Quinn said. “In 2011, there were 136 million ED visits, representing 45% of the US population. The improvements in HIV status in this ED population coincides with increased screening and linkage to care in the ED and the community.” – by Emily Shafer
Kelen G, et al. Abstract 98. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 23-26, 2015; Seattle.
Disclosure: Quinn reports no relevant financial disclosures.