Rapid HIV Testing by cy3MhAF

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									  HIV Screening in an Urban
   Emergency Department

The Highland Hospital Experience

           Douglas White, MD
     Alameda County Medical Center -
            Highland Hospital
              Oakland, CA
Scope of the Problem
 Scope of the Problem in U.S.
• >1,000,000 people in U.S. with HIV/AIDS
  – 25% unaware
• 40,000 new HIV infections/year
• Barriers to testing
  – Accessibility, fear, confidentiality, cost
• 30% people testing positive do not return for
  their results
       Why rapid HIV testing?
• Increase testing rates
• More people learn results
• Enables testing in non-traditional settings
   – Emergency Departments
   – Outreach
   – Private homes
             Highland Hospital
• Urban, academic, teaching hospital
• Emergency Department
  –   Regional trauma center
  –   Emergency Medicine Residency
  –   70,000 patient visits/year
  –   Diverse and Indigent patient population
  –   Staff 120 nurses
      Highland Project Overview
• Feasibility Study
  – CDC-funded, 2 year
  – Nursing-initiated HIV screening at triage
  – Routinely offer HIV testing to all eligible patients
  – Consent, testing, result disclosure (negatives)
    performed by nursing staff
  – ED physicians disclose preliminary positive
  – Streamlined testing and counseling protocol
              Bedside Testing




Oraquick ADVANCE HIV-1/2
 Project Results - Basic Counts
                            1/05 - 2/06

     Number tested            6,283
 Number Reactive Tests /
                             84 (1.3%)
   Preliminary Positive

   Confirmed Positives       82 (98%)

 Number False Positives       2 (2%)

     False Negatives         1 (.016%)

Number Linked to Care and
                            68/82 (83%)
   Treatment Services
 Results - Patient Satisfaction
  Newly Diagnosed Positives
• 96% rated experience as good -
  excellent
• 4% rated it as poor
                Conclusion
• Routine, voluntary HIV screening in an urban
  ED using indigenous staff is feasible
• Rapid testing with OraQuick ADVANCE using
  oral fluid is easy to perform
  – 120 nurses with minimal training
• The rapid test performance was in
  accordance with manufacturer’s reported
  accuracy
• Patient satisfaction is high
               OTC Application
• Many barriers still exist when seeking HIV testing
   –   Accessibility
   –   Stigma/fear
   –   Informed Consent
   –   Counseling
   –   Internal Resources
• An OTC test would provide the public with more HIV
  testing options

								
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