HIV testing in US EDs, 1993-2004.
OBJECTIVE
The aims of the study were to (1) estimate the incidence rates (IRs) of human immunodeficiency virus (HIV) testing among 13-year-old to 64-year-old patients in US emergency departments (EDs); (2) determine ED compliance with Centers for Disease Control and Prevention (CDC) recommendations for HIV testing for patients with nonsexual blood or body fluid exposures, sexually transmitted diseases (STDs), and sexual assaults; and (3) ascertain if HIV testing in EDs varies by patient demographic characteristics.


METHODS
The ED visits from the National Hospital Ambulatory Medical Care Survey databases (1993-2004) were analyzed. Visits for nonsexual blood or body fluid exposures, STDs, and sexual assaults were identified using diagnosis and cause codes. Incidence rates for HIV testing were estimated by year. Odds ratios (ORs) with 95% confidence intervals were estimated from multivariable logistic regression models using HIV testing as the outcome and demographic characteristics as covariates.


RESULTS
The average IR of HIV testing for 13-year-old to 64-year-old patients from 1993 to 2004 was 0.31%. Of all patients, 35.1% with nonsexual blood or body fluid exposures, 20.4% with sexual assaults, and 2.6% with STDs were tested for HIV. The HIV testing was more frequent among Hispanics (OR, 1.39 [1.06-1.81]), blacks (OR, 1.52 [1.19-1.94]), patients with Medicaid (OR, 2.35 [1.81-3.03]), Medicare (OR, 1.95 [1.20-3.16]), and self-pay/no charge/other type of insurance (OR, 1.74 [1.35-2.23]), and those visiting EDs in the northeastern United States (OR, 1.57 [1.04-2.38]).


CONCLUSIONS
The HIV testing rates are low in US EDs and have changed little for a 12-year period. Compliance with CDC recommendations for HIV testing is poor and not in accordance with risk for infection. Hispanics, blacks, and those without private health care insurance are being tested more frequently than other ED patients.
Merchant
Roland C
RC
Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. rmerchant@lifespan.org
Catanzaro
Bethany M
BM
D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000175:diagnosis*; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D014481:United States; D055815:Young Adult
Ann Emerg Med. 2002 Jun;39(6):631-8
12023706
MMWR Morb Mortal Wkly Rep. 1996 Jun 7;45(22):468-80
8622618
AIDS Patient Care STDS. 2005 Apr;19(4):239-46
15857195
J Gen Intern Med. 2004 Apr;19(4):349-56
15061744
MMWR Recomm Rep. 2002 May 10;51(RR-6):1-78
12184549
MMWR Recomm Rep. 2006 Sep 22;55(RR-14):1-17; quiz CE1-4
16988643
J Acquir Immune Defic Syndr. 2004 Jan 1;35(1):52-5
14707792
MMWR Recomm Rep. 1998 May 15;47(RR-7):1-33
9603630
MMWR Recomm Rep. 1993 Sep 24;42(RR-14):1-102
8145706
MMWR Morb Mortal Wkly Rep. 1987 Aug 14;36(31):509-15
3112540
MMWR Recomm Rep. 2006 Aug 4;55(RR-11):1-94
16888612
MMWR Morb Mortal Wkly Rep. 2006 Dec 1;55(47):1269-72
17136020
MMWR Recomm Rep. 1998 Jan 23;47(RR-1):1-111
9461053
MMWR Morb Mortal Wkly Rep. 2001 Jun 29;50(25):538-41
11446572
MMWR Recomm Rep. 2001 Nov 9;50(RR-19):1-57; quiz CE1-19a1-CE6-19a1
11718472
AIDS Patient Care STDS. 2002 Nov;16(11):549-53
12513903
Am J Obstet Gynecol. 1998 Jun;178(6):1264-71
9662311
MMWR Recomm Rep. 2005 Sep 30;54(RR-9):1-17
16195697
Am J Emerg Med. 1999 Jul;17(4):354-6
10452432
Vital Health Stat 10. 2006 May;(228):1-164
25116270