Difficulties of routine rapid HIV screening in emergency department

Background

To evaluate the feasibility of routine rapid HIV screening in an emergency department of a general hospital.

Methods

From January 2008 to August 2008, all patients admitted from 8 AM to 4 PM to the emergency unit of the hospital were offered a rapid screening for HIV infection. After inform consent, HIV rapid test was performed by the biology laboratory. Result of the test was transmitted to the clinicians who informed the patient of the result of his test. An ELISA was systematically performed later to confirm the results of the rapid test.

Results

During the period of the study, 16 024 patients were admitted to the emergency department. Routine screening was proposed to 420 patients. 19 patients denied the test. So, only 401 HIV tests have been performed (2,5% of the total number of eligible patients). 1 test was positive (0,25%). No discordance between rapid tests and ELISA were observed.

Discussion

Despite a high acceptance of screening by the patients and high sensibility and specificity of rapid tests, these results seem disappointing. Only a very low minority of patients were offered an HIV screening. The main explanation seems to be a reluctance of clinicians to propose the test to their patients. Arguments advanced by physicians to explain this were various: lack of time, reluctance to obtain inform consent, questions about the interest of routine HIV screening in emergency department... So, reflections must be conducted to increase the acceptance of routine screening by physicians. One of the promising options would be to use an opt-out procedure.