We should routinely offer HIV testing to Emergency Department

patients

Adrian Boyle

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

HIV is not a death sentence

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)

It’s unacceptable!

• Antenatal care

• Highly accepted in pilots (64% taken when offered)

• Social stigma is much less than 20 years ago

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?

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

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

We shouldn’t

• Do this alone

• POCT

• Try to cope and make do