Methods: In July 2017, electronic medical record (EMR) based universal opt-out HIV screening [Architect HIV antibody (Ab) / HIV p24 antigen detection] for persons aged 13-64 years (excluding persons known HIV+ or reporteing an HIV test within the last 12 months) was implemented in our EDs. The EMR algorithm also identified HIV+ individuals who had been out of care for >12 months. In March 2018, EMR based universal HCV screening for birth cohort was added in both EDs.
Results: Over a period of 9 months 7303 HIV tests were conducted, resulting in 24 (0.3%) new HIV diagnoses, of which 21 were successfully linked to care. In 5 individuals without HIV infection Architect gave a false positive result (specificity 99.93%). In addition, the EMR algorithm identified 38 out of care HIV+ individuals of which 21 were successfully relinked to care. During the 1-month HCV birth cohort screening 963 HCV Ab tests were conducted, of which 106 (11%) resulted positive. At the time being 78 of those seropositive individuals had HCV RNA testing, of which 36 (53%) resulted positive (3.7% of all participants).
Conclusion: In San Diego, a setting with a high density of free-of charge HIV screening programs, 1/300 HIV tests in the ED yielded a new HIV diagnosis and in total 21 newly diagnosed individuals were linked to care. Identification of HIV+ out of care individuals yielded in an equivalent number of individuals relinked to care. The rate of newly diagnosed HCV infections exceeded the rate of newly diagnosed HIV infections by >10-fold outlining the importance of screening for HCV in the ED.
J. Blumenthal, None
G. Vilke, None
S. Little, None