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Implementing an HIV and sexually transmitted disease screening program in an emergency department.
Annals of Emergency Medicine 2007; 49(5):564-572.
Silva A, Glick NR, Lyss SB, Hutchinson AB, Gift TL, Pealer
LN, Broussard D, Whitman S.
Abstract
STUDY OBJECTIVE: We assess the feasibility, effectiveness, and cost of routinely
recommended HIV/sexually transmitted disease screening in an urban emergency
department (ED). METHODS: From April 2003 to August 2004, patients aged 15
to 54 years were offered rapid HIV testing, and those aged 15 to 25 years
were also offered gonorrhea and chlamydia testing (nucleic acid amplification),
Monday through Friday, 11 am to 8 pm. Infected patients were referred for
treatment and care. Prevalence, treatment rates, and cost were assessed. RESULTS:
Among 3,030 patients offered HIV testing, 1,447 (47.8%) accepted, 8 (0.6%)
tested positive, and 3 (37.5%) were linked to care. Among 791 patients offered
sexually transmitted disease testing, 386 (48.8%) accepted, 320 provided urine
(82.9%), 48 (15.0%) tested positive, and 42 (87.5%) were treated for gonorrhea
or chlamydia. The program cost was $72,928. Costs per HIV-infected patient
identified and linked to care were, respectively, $9,116 and $24,309; cost
per sexually transmitted disease-infected patient treated was $1,736. The
program cost for HIV/sexually transmitted disease screening was only $14,340
more than if we screened only for HIV. CONCLUSION: Through ED-based HIV/sexually
transmitted disease screening, we identified and treated many sexually transmitted
disease-infected patients but identified few HIV-infected patients and linked
even fewer to care. However, sexually transmitted disease screening can be
added to HIV screening at a reasonable cost.