Objectives and Backgrounds With the availability of highly active antiretroviral therapy, HIV is now very treatable. However, a third of those with HIV remain undiagnosed and the majority of deaths occurring in those with HIV are due to late diagnosis.
Aims To improve the detection rate of HIV early to offer people the opportunity to tackle the disease more effectively. To assess acceptability of the test to patients and staff within the ED.
Methods Eligible patients were adults between 18 and 65 who attend the ED from 1 to 31 March 2011 having blood tests and able to consent. A trained member of staff obtained verbal consent. Patients were given an information leaflet and opportunity to ask questions. Testing was undertaken by laboratory staff and a telephone results line set up. Positive results were followed up by GUM staff. A survey was sent to the ED staff for further feedback.
Results Results 2726 eligible patients had blood tests taken during the pilot period. 584 HIV tests were taken. Three new positives were diagnosed. In addition at least two patients with known HIV also attended during giving a prevalence of 0.85%. Over 50% of patients declined testing. The commonest reason was that they did not perceive that they were at risk. A minority were offended by being offered the test. The majority of staff responding to the survey were comfortable offering HIV testing (86%) and felt it appropriate to offer the test in the ED (81%).
Conclusions Most staff who answered the survey were happy to offer HIV testing. However, in many cases, the test was not offered or patients declined. Further training of the ED staff would be beneficial as we could have missed opportunities to pick up many more positives. Although three new diagnoses is a small number, this gives a prevalence that far exceeds the 2 in 1000 suggested by national HIV guidelines to make offering routine testing worthwhile. However, further cost analysis and assessment of overall impact on the ED would need to be done before we could continue to offer routine testing.
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