495. Effectiveness of Rapid HIV Testing in an Urban Emergency Department in New Orleans at Re-Engaging Previously HIV Positive Patient to HIV Specialty Care
Session: Poster Abstract Session: HIV Testing and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • Poster 495.pdf (266.3 kB)
  • Background: The purpose of the study is to determine how effective the institution of rapid HIV testing is in linking and re-engaging patients with known HIV who are out of care into HIV specialty care. 

    Methods: A retrospective review of the medical records of patients who agreed to a rapid HIV test in the emergency department in the initial year of institution of the rapid test (2008) was conducted.

    Results:  One hundred and thirty eight patients out of 8,204(1.7%) patients tested positive for HIV in the first year of the institution of the rapid HIV test. Three (2%) were false positives and thirty six (26%) had a previous diagnosis of HIV.  Among the patients with a previous diagnosis of HIV, 7 patients (19%) were already in care, defined as a visit to an HIV specialist in the previous six months.  Of the remaining 29 patients, 19 (66%) were male, 23 (79%) were African-American, and the average age was 39 (range 26 to 58), which was similar to the demographics of the newly diagnosed patients.  Fifty seven percent of these patients had a CD4 count less than 200 at the time of the rapid test.  The mean CD4 count was 178 (95% CI 78 to 277).  Thirteen were linked to care (45%) within 3 months, 16 (55%) within 6 months, and 18 (62%) within 1 year.  In the first year the newly linked patients had an average of 4.3 visits to an HIV specialist, in the second year the average number of visits was 3.9 visits. Seven of the 18 (39%) were not retained in care, as defined as less than 2 visits per year in their second year of care. Mean CD4 counts of the linked patients at two years was 208 (95% CI 62 to 354), which was not significantly different from baseline values. 

    Conclusion:  Rapid HIV testing in the emergency department was an effective intervention for linking and re-engaging patients with known HIV.  In the first year of institution, the rapid test successfully identified 29 patients with a previous diagnosis of HIV that were out of care and linked the majority (62%) of these patients to an HIV specialist.  Patients with a previous diagnosis of HIV, who were out of care, were difficult to retain in care. The non-significant changes in CD4 counts may be a reflection of lower clinic and medication adherence, which are more prevalent in an out of care population.    



    Subject Category: H. HIV/AIDS and other retroviruses

    John Humphrey, MD, Internal Medicine/Pediatrics, Tulane University Hospital, New Orleans, LA, LA, Christiane Hadi, MD, MPH, Infectious Disease Division, Washington University in St. Louis, St. Louis, MO and Lauren Richey, MD, MPH, Infectious Diseases Section, Tulane University, New Orleans, LA

    Disclosures:

    J. Humphrey, None

    C. Hadi, None

    L. Richey, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.