title: Feasibility of an emergency department-based, risk-targeted voluntary HIV screening program.
abstract: OBJECTIVE
  To assess the feasibility and effectiveness of an emergency department-based, risk-targeted voluntary HIV screening program.
  
  
  METHODS
  We prospectively enrolled consenting adult i.v. drug users (IDUs) not known to have HIV infection in the ED of a large inner-city hospital with a high rate of HIV infection among patients during a 10-week trial. Study patients were given confidential HIV pretest and risk-reduction counseling, with 10- to 14-day on-site ED follow-up. Follow-up included posttest counseling, reinforcement of risk-reduction practices, and a +10 incentive to cover transportation costs. HIV seropositive patients were referred to the hospital HIV clinic for further evaluation and treatment.
  
  
  RESULTS
  Of 200 eligible IDUs, 168 (84%) consented to HIV testing. Of the 104 (62%) who returned for follow-up, 17 (16%) tested positive for HIV. Of these patients, 6 (35%) kept their initial hospital HIV clinic referral appointment, a rate consistent with the experience of the hospital HIV clinic. Of nine patients in whom CD4+ counts were performed at time of the visit, three (33%) had counts less than 200. At 3-month follow-up, 4 of 20 active IDUs (20%) had reportedly ceased drug use because of the program. The complete program costs was an estimated $16,659, $99 per enrolled patient and $521 per HIV-positive patient.
  
  
  CONCLUSIONS
  An ED-based, risk-targeted HIV screening program is feasible and over time could detect a significant number of asymptomatic HIV-infected individuals, including those who should receive antiretroviral therapy and prophylaxis for Pneumocystis carinii pneumonia therapy (CD4+ count less than 200). An additional benefit of ED-based HIV screening in high-prevalence EDs is the opportunity to conduct successful risk-reduction counseling in some high-risk individuals.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: G D
authors.initials: GD
authors.lastname: Kelen
authors.forename: D A
authors.initials: DA
authors.lastname: Hexter
authors.forename: K N
authors.initials: KN
authors.lastname: Hansen
authors.forename: R
authors.initials: R
authors.lastname: Humes
authors.forename: P N
authors.initials: PN
authors.lastname: Vigilance
authors.forename: M
authors.initials: M
authors.lastname: Baskerville
authors.forename: T C
authors.initials: TC
authors.lastname: Quinn
mesh_terms: D015492:AIDS Serodiagnosis; D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D003219:Confidentiality; D003376:Counseling; D004636:Emergency Service, Hospital / Q000191:economics; D005240:Feasibility Studies; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis*; D017048:Health Care Costs; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation; D015819:Substance Abuse, Intravenous / Q000150:complications*