by Arizona AETC collaborated with Banner University Medical Center and Arizona Department of Health Services to expand HIV testing in two Tucson emergency departments. When the project began in 2012, both emergency departments rarely tested patients for HIV, one had an outdated HIV testing policy requiring written consent, and both were using 3rd generation HIV antibody testing technology. Arizona AETC worked with 10+ departments to expand emergency department HIV testing and set-up a streamlined linkage to care process for patients testing positive.
Through discussions with emergency department leadership, a plan for a targeted HIV testing program emerged, with a focus on resident-driven HIV testing. In order to prepare for the testing program roll-out, Arizona AETC worked with the labs to switch to the CDC recommended 4th generation HIV testing algorithm, updated the hospital HIV testing policy to a universal screening policy and trained residents, nurses and social workers on the HIV testing protocol.
The targeted HIV testing program began in August 2013 and continues today with one emergency department testing an average of 130 patients/month and the other testing 95 patients/month. The testing programs are sustainable and not supported by outside funds. HIV screening has been integrated in the culture of the emergency department and is generally accepted by attending physicians and residents. Between August 2013 and April 2017, the emergency departments tested over 9500 patients for HIV and identified 42 new cases of HIV including 7 acute HIV cases. Many of these cases would not have been identified if the HIV testing program did not exist.
Recently, a 21-year-old male presented in the emergency department with a fever, nausea and diarrhea. He thought he had the stomach flu and was uninsured which is why he was seeking care at the emergency department. The resident took the patient’s social history, which included questions about sex partners, and recommended HIV testing. The patient’s test came back positive and his viral load was over 10 million copies- he had acute HIV. Thanks to the lab’s 4th generation HIV test, which can detect HIV within 2 weeks of infection, the patient was identified as acute HIV. Had the patient presented to the emergency department 5 years ago, the resident likely would not have asked about sex partners or recommended HIV testing, and the 3rd generation would certainly not have detected HIV infection. The patient was linked to HIV care, where case managers helped the patient enroll in health insurance, expert physicians treated his acute HIV and pharmacists counseled him on medication adherence to help him achieve viral suppression.