C6b Missed Opportunities for STD and HIV Testing in a North Carolina Emergency Department

Wednesday, March 10, 2010: 10:45 AM
Grand Ballroom C (M4) (Omni Hotel)
Pamela Klein, BA1, Brooke Hoots, MSPH1, Peter Moore, MPH2, Jan Scott, BA2 and Peter Leone, MD3, 1Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, 2Centers for Disease Control and Prevention, Raleigh, NC, 3HIV/STD Prevention and Control Branch, North Carolina Department of Health and Human Services, Raleigh, NC

Background: In 2008, a North Carolina Emergency Department (ED) implemented a targeted HIV testing program. Due to the importance of HIV/STD co-infections and the high STD prevalence in North Carolina, physicians were instructed to recommend HIV testing for all patients with an STD test order, among other targeted indications.

Objectives: To assess the agreement between syphilis and HIV test orders and evaluate the ED HIV testing program.

Methods: Analysis included patients visiting the ED from January 1, 2008 through March 31, 2009; individual ED visits were used as the unit of analysis. Kappa statistics evaluated agreement between syphilis test (RPR) and HIV test orders.

Results: Of the 142,470 visits to the ED during the study period, 420 (0.3%) patients had an HIV test performed and 554 (0.4%) patients had an RPR test performed.  Agreement between RPR and HIV test orders was low (kappa = 0.35, 95% CI: 0.30, 0.40). The positivity rates for the HIV and syphilis tests were 6.0% (25/420) and 5.8% (32/554), respectively. Only 31% (173/554) of patients receiving an RPR test also had an HIV test performed. Of these, 8 (4.6%) tested positive for HIV and 15 (8.7%) tested positive for syphilis; 4 (2.3%) were co-infected with both HIV and syphilis.

Conclusions: All patients receiving an STD test in clinical settings should also be tested for HIV.  However, almost 60% of patients receiving a syphilis test in the ED did not concurrently receive an HIV test, indicating missed opportunities to provide both HIV and STD testing in a high-prevalence community.

Implications for Programs, Policy, and/or Research: Efforts should be made to increase adherence to national and facility-level HIV/STD testing guidelines and promote the integration of HIV/STD screening programs in clinical settings.