Evaluation of an Emergency Department Referral System for Outpatient HIV Testing

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Abstract
Undiagnosed HIV infection is prevalent among patients who present to urban emergency departments (EDs). Providing appropriate counseling, testing, and follow-up in the ED is difficult. The aim of this study was to evaluate the effectiveness of a referral-based outpatient HIV testing system for patients referred from the ED. This was a prospective cohort study performed at an urban teaching hospital. Consecutive patients referred from the emergency department (ED) for outpatient HIV testing were enrolled. Data were collected from each patient's ED record and HIV clinic record, if applicable. Of the 586 referrals made from our ED, 494 (84%) met inclusion criteria. Only 56 patients (11%, 95% CI: 9–15%) arrived at the HIV clinic and completed pretest counseling. Of these, 51 (91%, 95% CI: 80–97%) tested negative for HIV, 4 (7%, 95% CI: 2–17%) tested positive for HIV, and 1 (2%, 95% CI: 0–10%) refused the test. This referral system was ineffective at identifying unrecognized HIV infection due to poor adherence. Changes in the structure of the referral system or the use of point-of-care testing in the ED may improve the ability to detect HIV infection in this setting.