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We should routinely offer HIV testing to Emergency Department
patients
Adrian Boyle
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Why should we offer HIV testing?
• 77,000 people in the UK are thought to have HIV
• 20,000 of these are unaware of their positive status
• Early diagnosis saves lives and improves the quality of life
• Early diagnosis reduces onward transmission
• Early diagnosis is cost effective
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HIV is not a death sentence
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Why the ED?
• Prevalence rates in London EDs are three times higher the local prevalence (3% at St Mary’s)
• ‘Hard to reach’ patients– IVDUs/ Immigrants / Chronically excluded
adults / Young men / Unregistered patients
• Pilot data (C&W shows 0.5% new positive rate)
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It’s unacceptable!
• Antenatal care
• Highly accepted in pilots (64% taken when offered)
• Social stigma is much less than 20 years ago
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It’s too expensive!
• Cost effectiveness established in areas where local prevalence exceeds 2/1,000– Luton 4.31 – Southend 2.72– Harlow 2.38
• An HIV test costs £15• A positive case costs around £5,000 for the first FCE• Previously undiagnosed positive rates are about 0.5%
(so spend £3,000 pounds for one positive test)• Early diagnosis saves £8,000 year
• How much does your ED spend on clotting screens a year?
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The results management is too difficult!
ED clinician consents patient
Sample tested
Positive result Negative result
GU Physician contacts patient, informs, contact traces, initiates
treatment
No action required
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HIV versus Diabetes
HIV• Social stigma• Undiagnosed
prevalence substantial
• Early treatment reduces morbidity and mortality
• Easily testable
Diabetes
• Social stigma
• Undiagnosed prevalence substantial
• Early treatment reduces morbidity and mortality
• Easily testable
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We shouldn’t
• Do this alone
• POCT
• Try to cope and make do