High-level compliance to opt-out HIV testing in the emergency department (ED) of a large teaching hospital using the biochemistry sample as the sample type for HIV screening.

INTRODUCTION: HIV remains a key public health issue. National Institute for Health and Care Excellence and British HIV Association guidance recommends that patients should be offered HIV testing when admitted to hospital or attending emergency departments (EDs) in areas with a prevalence ≥ 2 per 1000. We report a novel method of testing and the first 3-year results from our HIV ED testing programme utilizing biochemistry samples for HIV testing, with the aim of improving uptake while ensuring no changes to clinical practice in EDs. METHODS: Routine ED HIV testing was implemented on 1 October 2018; it was initially opt-in and was subsequently changed to opt-out on 1 February 2019. HIV testing was added to all ED blood test order sets and was performed on the biochemistry samples of those aged 18-59 years. The age range was extended to include those aged 16+ years on 1 March 2021 along with a move to notional consent. RESULTS: A total of 78 333 HIV tests were performed from an estimated 110 683 attendees who had bloods taken in the same age range, demonstrating an overall 69.5% testing coverage. On implementation of opt-out testing after the first 4 months, the proportion of tests increased (from 57.9% to 69%). After increase in age range to 16+ years and a move to notional consent, the overall testing coverage improved to 74.2%. Of 1054 reactive results, 728 (69%) were known people living with HIV, eight (0.8%) were not contactable, two (0.2%) re-tested elsewhere and three (0.3%) declined a re-test. A total of 259 false-positives were determined by follow-up testing and 50 (4.8%) were newly diagnosed with HIV. An HIV diagnosis was suspected in only 22%, and 48% had never previously tested for HIV. CONCLUSIONS: An opt-out HIV testing programme with notional consent and using biochemistry samples within the ED is feasible, acceptable and provides an excellent opportunity to diagnose patients who do not perceive themselves to be at risk or have never tested before.

Routine HIV testing in the Emergency Department: feasible and acceptable?

Routine HIV testing in non-specialist settings has the potential to significantly reduce late diagnosis and delay in treatment. The objective was to determine the feasibility and acceptability of HIV testing in an Emergency Department (ED) at a busy London teaching hospital. We conducted an observational cross sectional study between March-May 2012 where patients aged between 18-65 years attending St George's ED having serological tests were offered HIV testing by ED clinical staff. Patients were given an information leaflet on HIV, including how to obtain results. Data detailing whether the test was offered (feasibility) and whether the patient consented to the test (acceptability) were documented. Information regarding reasons for not offering HIV testing and reasons why the test was declined was also recorded. During the study period, 24,171 patients aged 18-65 were seen in the ED. Data were collected from 5657 patients. The mean age was 38 years, 57% were female and 27% identified themselves as white. 48% were offered HIV testing, of which 65% accepted. Incapacity to consent to testing was cited by clinicians as the commonest reason for not offering an HIV test (76%). 'Recent HIV test' was the commonest reason for declining a test (38%). One new HIV diagnosis was made. Our experience demonstrates that routine HIV testing in the ED is feasible and acceptable. However, to make HIV testing effective and part of routine clinical care, considerable clinical leadership, staff training and additional resources are required.