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Risk factors for HIV infection at a large urban emergency department: a cross-sectional study
  1. James S Ford1,
  2. Mohammad A Mousa2,
  3. Stephanie Voong2,
  4. Cynthia G Matsumoto3,
  5. Tasleem Chechi2,
  6. Nam Tran4,
  7. Larissa May2
  1. 1 Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
  2. 2 Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
  3. 3 Department of Population Health and Accountable Care, University of California Davis Health, Sacramento, CA, USA
  4. 4 Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA, USA
  1. Correspondence to Dr James S Ford, Emergency Medicine, University of California San Francisco, San Francisco, California 94143, USA;{at}


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.

  • HIV
  • screening
  • public health
  • risk factors

Data availability statement

Data are available on reasonable request.

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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.