title: Using nonrapid HIV technology for routine, opt-out HIV screening in a high-volume urban emergency department.
abstract: OBJECTIVE
  We implement an opt-out routine screening program in a high-volume, urban emergency department (ED), using conventional (nonrapid) technology as an alternative to rapid HIV tests.
  
  
  METHODS
  We performed a retrospective cohort study. Since October 2008, all patients who visited Ben Taub General Hospital ED and had blood drawn were considered eligible for routine opt-out HIV screening. The hospital is a large, publicly funded, urban, academic hospital in Houston, TX. The ED treats approximately 8,000 patients monthly. Screening was performed with standard chemiluminescence technology, batched hourly. Patients with positive screening test results were informed of their likely status, counseled by a service linkage worker, and offered follow-up care at an HIV primary care clinic. Confirmatory Western blot assays were automatically performed on all new HIV-positive samples.
  
  
  RESULTS
  Between October 1, 2008, and April 30, 2009, 14,093 HIV tests were performed and 39 patients (0.3%) opted out. Two hundred sixty-two (1.9%) HIV test results were positive and 80 new diagnoses were made, for an incidence of new diagnoses of 0.6%. There were 22 false-positive chemiluminescence results and 7 indeterminate Western blot results. Nearly half the patients who received a new diagnosis were not successfully linked to HIV care in our system.
  
  
  CONCLUSIONS
  Opt-out screening using standard nonrapid technology, rather than rapid testing, is feasible in a busy urban ED. This method of HIV screening has cost benefits and a low false-positivity rate, but aggressive follow-up and referral of patients with new diagnoses for linkage to care is required.
authors.affiliation: Baylor College of Medicine, Houston, TX, USA. hoxhaj@bcm.edu
authors.forename: Shkelzen
authors.initials: S
authors.lastname: Hoxhaj
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Davila
authors.forename: Payal
authors.initials: P
authors.lastname: Modi
authors.forename: Neal
authors.initials: N
authors.lastname: Kachalia
authors.forename: Ken
authors.initials: K
authors.lastname: Malone
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ruggerio
authors.forename: Nancy
authors.initials: N
authors.lastname: Miertschin
authors.forename: Patricia
authors.initials: P
authors.lastname: Brock
authors.forename: Angela
authors.initials: A
authors.lastname: Fisher
authors.forename: Beau
authors.initials: B
authors.lastname: Mitts
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods* / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D019411:Clinical Laboratory Techniques / Q000523:psychology / Q000706:statistics & numerical data; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000175:diagnosis; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D013781:Texas; D055815:Young Adult