Twelve months of routine HIV screening in 6 emergency departments in the Paris area: results from the ANRS URDEP study.
OBJECTIVE
In October 2009 the French National Authority for Health recommended that HIV testing be proposed at least once to all persons aged 15 to 70 years in all healthcare settings. We examined whether routine HIV screening with a rapid test in emergency departments (EDs) was feasible without dedicated staff, and whether newly diagnosed persons could be linked to care.


METHODS
This one-year study started in December 2009 in 6 EDs in the Paris area, using the INSTI™ test. Eligible individuals were persons 18 to 70 years old who did not present for a vital emergency, for blood or sexual HIV exposure, or for HIV screening. Written informed consent was required.


RESULTS
Among 183 957 eligible persons, 11 401 were offered HIV testing (6.2%), of whom 7936 accepted (69.6%) and 7215 (90.9%) were tested (overall screening rate 3.9%); 1857 non eligible persons were also tested. Fifty-five new diagnoses of HIV infection were confirmed by Western blot (0.61% (95% CI 0.46-0.79). There was one false-positive rapid test result. Among the newly diagnosed persons, 48 (87%) were linked to care, of whom 36 were not lost to follow-up at month 6 (75%); median CD4 cell count was 241/mm(3) (IQR: 52-423/mm(3)).


CONCLUSIONS
Screening rates were similar to those reported in opt-in studies with no dedicated staff. The rate of new diagnoses was similar to that observed in free anonymous test centres in the Paris area, and well above the prevalence (0.1%) at which testing has been shown to be cost-effective.
AP-HP, Groupe Hospitalier Universitaire Paris Nord-Val de Seine, Service d'accueil des Urgences, Paris, France.
Enrique
E
Casalino
Bruno
B
Bernot
Olivier
O
Bouchaud
Chakib
C
Alloui
Christophe
C
Choquet
Elisabeth
E
Bouvet
Florence
F
Damond
Sandra
S
Firmin
Aurore
A
Delobelle
Beatrice Ename
BE
Nkoumazok
Guillaume
G
Der Sahakian
Jean-Paul
JP
Viard
Olivier Zak Dit
OZ
Zbar
Elisabeth
E
Aslangul
Anne
A
Krivine
Julie
J
Zundel
Jade
J
Ghosn
Patrice
P
Nordmann
Yann-Erick
YE
Claessens
Tassadit
T
Tahi
Bruno
B
Riou
Agnès
A
Gautheret-Dejean
Christine
C
Katlama
Pierre
P
Hausfater
Françoise
F
Brun-Vézinet
Dominique
D
Costagliola
D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult