Modest public health impact of nontargeted human immunodeficiency virus screening in 29 emergency departments.
BACKGROUND
To lower the number of undiagnosed infections and to improve early detection, international health agencies have promoted nontargeted human immunodeficiency virus (HIV) screening in health care settings, including emergency departments (EDs). This strategy remains controversial and has yet to be tested on a large scale. We assessed the public health impact of nontargeted HIV-rapid test (RT) screening among ED patients in the metropolitan area of Paris (11.7 million inhabitants), where half of France's new HIV cases are diagnosed annually.


METHODS
During a randomly assigned 6-week period for each of the 29 participating EDs, 18- to 64-year-old patients who were able to provide consent for HIV testing were offered a fingerstick whole-blood HIV RT. Main outcome measures were the number of patients tested for HIV and their characteristics vs those of the general metropolitan Paris population and the proportion of newly diagnosed HIV-positive patients among those tested and their characteristics vs those from the national HIV case surveillance.


RESULTS
Among 138,691 visits, there were 78,411 eligible patients, 20,962 of whom (27.0%) were offered HIV RT; 13,229 (63.1%) accepted testing and 12,754 (16.3%) were tested. The ED patients' characteristics reflected the general population distribution. Eighteen patients received new HIV diagnoses (0.14%; 95% confidence interval, 0.08%-0.22%). Like national HIV case surveillance patients, they belonged to a high-risk group (n = 17), were previously tested (n = 12), and were either symptomatic or had a CD4 lymphocyte count lower than 350/μL, suggesting late-stage infections (n = 8); 12 patients were linked to care.


CONCLUSIONS
Nontargeted HIV testing in EDs was feasible but identified only a few new HIV diagnoses, often at late stages, and, unexpectedly, most patients belonged to a high-risk group. Our findings do not support the implementation of nontargeted screening of the general population in EDs.
Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Centre de Recherche en Épidémiologie et Santé des Populations, Villejuif, France.
Kayigan Wilson
KW
d'Almeida
Gérald
G
Kierzek
Pierre
P
de Truchis
Stéphane
S
Le Vu
Dominique
D
Pateron
Bertrand
B
Renaud
Caroline
C
Semaille
Vanina
V
Bousquet
François
F
Simon
Didier
D
Guillemot
France
F
Lert
Anne-Claude
AC
Crémieux
D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D055815:Young Adult