Objectives In 2019, the US Preventative Services Task Force released updated guidelines recommending HIV screening in all individuals aged 15–64 years and all pregnant females. In the current study, we aimed to identify risk factors for HIV infection in an emergency department (ED) population.
Methods We performed a cross-sectional study that employed a post hoc risk factor analysis of ED patients ≥18 years who were screened for HIV between 27 November 2018 and 26 November 2019, at a single urban, quaternary referral academic hospital. Patients were screened using HIV antigen/antibody testing and diagnoses were confirmed using HIV-1/HIV-2 antibody testing. The outcome of interest was the number of positive HIV tests. Multiple logistic regression models were used to identify risk factors associated with HIV positivity.
Results 14 335 adult patients were screened for HIV (mean age: 43±14 years; 52% female). HIV seroprevalence was 0.7%. Independent risk factors for HIV positivity included male sex (adjusted OR (aOR) 3.1 (95% CI 1.7 to 5.6)), unhoused status (aOR 2.9 (95% CI 1.7 to 4.9)), history of illicit drug use (aOR 1.8 (95% CI 1.04 to 3.13)) and Medicare insurance status (aOR 2.2 (95% CI 1.1 to 4.4)).
Conclusions The study ED services a high-risk population with regard to HIV infection. These data support universal screening of ED patients for HIV. Risk factor profiles could improve targeted screening at institutions without universal HIV testing protocols.
- public health
- risk factors
Data availability statement
Data are available on reasonable request.
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Handling editor Jamie Scott Frankis
Contributors JSF, SV, TC, NT and LM conceived the study. LM obtained funding. JSF managed the data. JSF and CGM analysed the data. JSF and LM interpreted the data. JSF, MAM and SV drafted the manuscript, and all authors contributed substantially to its revision. LM takes responsibility for the paper as a whole and is acting as the guarantor.
Funding This work was supported by Gilead’s FOCUS programme. In the USA, the FOCUS Programme is a public health initiative that enables partners to develop and share best practices in routine bloodborne virus (HIV, HCV, HBV) screening, diagnosis and linkage to care in accordance with screening guidelines promulgated by the US Centers for Disease Control and Prevention (CDC), the US Preventive Services Task Force and state and local public health departments. FOCUS funding supports HIV, HCV and HBV screening and linkage to a first appointment. FOCUS partners do not use FOCUS awards for activities beyond linkage to a first appointment.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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