Preventive care in the emergency department: should emergency departments conduct routine HIV screening? a systematic review.
OBJECTIVE
To perform a systematic review of the emergency medicine literature to assess the appropriateness of offering routine HIV screening to patients in the emergency department (ED).


METHODS
The systematic review was conducted with the aid of a structured template, a companion explanatory guide, and a grading and methodological scoring system based on published criteria for critical appraisal. Two reviewers conducted independent searches using OvidR, PubMed, MD Consult, and Grateful Med. Relevant abstracts were reviewed; those most pertinent to the stated objective were selected for complete evaluation using the structured template.


RESULTS
Fifty-two relevant abstracts were reviewed; of these, nine were selected for detailed evaluation. Seven ED-based prospective cross-sectional seroprevalence studies found HIV rates of 2-17%. Highest rates of infection were seen among patients with behavioral risks such as male homosexual activity and intravenous drug use. Two studies demonstrated feasibility of both standard and rapid HIV testing in the ED, with more than half of the patients approached consenting to testing by either method, consistent with voluntary testing acceptance rates described in other settings. Several cost-benefit analyses lend indirect support for HIV screening in the ED.


CONCLUSIONS
Multiple ED-based studies meeting the Centers for Disease Control and Prevention Guideline threshold to recommend routine screening, in conjunction with limited feasibility trials and extrapolation from cost-benefit studies, provide evidence to recommend that EDs offer HIV screening to high-risk patients (i.e., those with identifiable risk factors) or high-risk populations (i.e., those where HIV seroprevelance is at least 1%).
Rothman
Richard E
RE
Johns Hopkins University, Department of Emergency Medicine (RER, KSK, GDK), Baltimore, MD 21205, USA. rrothman@jhmi.edu
Ketlogetswe
Kerunne S
KS
Dolan
Teresa
T
Wyer
Peter C
PC
Kelen
Gabor D
GD
D015492:AIDS Serodiagnosis / Q000191:economics / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000191:economics / Q000592:standards; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D015528:HIV Seroprevalence; D006801:Humans; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors