NDLI: Randomized comparison of universal and targeted HIV screening in the emergency department.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Lyons, Michael S. Lindsell, Christopher J. Ruffner, Andrew H. Wayne, D. Beth Hart, Kimberly W. Sperling, Matthew I. Trott, Alexander T. Fichtenbaum, Carl J.
Spatial Coverage	United States Ohio
Description	Author Affiliation: Lyons MS ( *Department of Emergency Medicine)
Abstract	OBJECTIVE: Universal HIV screening is recommended but challenging to implement. Selectively targeting those at risk is thought to miss cases, but previous studies are limited by narrow risk criteria, incomplete implementation, and absence of direct comparisons. We hypothesized that targeted HIV screening, when fully implemented and using maximally broad risk criteria, could detect nearly as many cases as universal screening with many fewer tests. METHODS: This single-center cluster-randomized trial compared universal and targeted patient selection for HIV screening in a lower prevalence urban emergency department. Patients were excluded for age (<18 and >64 years), known HIV infection, or previous approach for HIV testing that day. Targeted screening was offered for any risk indicator identified from charts, staff referral, or self-disclosure. Universal screening was offered regardless of risk. Baseline seroprevalence was estimated from consecutive deidentified blood samples. RESULTS: There were 9572 eligible visits during which the patient was approached. For universal screening, 40.8% (1915/4692) consented with 6 being newly diagnosed [0.31%, 95% confidence interval (CI): 0.13% to 0.65%]. For targeted screening, 37% (1813/4880) had no testing indication. Of the 3067 remaining, 47.4% (1454) consented with 3 being newly diagnosed (0.22%, 95% CI: 0.06% to 0.55%). Estimated seroprevalence was 0.36% (95% CI: 0.16% to 0.70%). Targeted screening had a higher proportion consenting (47.4% vs. 40.8%, P < 0.002), but a lower proportion of ED encounters with testing (29.7% vs. 40.7%, P < 0.002). CONCLUSIONS: Targeted screening, even when fully implemented with maximally permissive selection, offered no important increase in positivity rate or decrease in tests performed. Universal screening diagnosed more cases, because more were tested, despite a modestly lower consent rate.
File Format	HTM / HTML
ISSN	15254135
e-ISSN	10779450
DOI	10.1097/QAI.0b013e3182a21611
Journal	JAIDS Journal of Acquired Immune Deficiency Syndromes
Issue Number	3
Volume Number	64
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2013-11-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline AIDS Emergency Service, Hospital Hiv Infections Diagnosis Mass Screening Statistics & Numerical Data Patient Acceptance Of Health Care Adolescent Cluster Analysis Early Diagnosis Epidemiology Prevention & Control Hospitals, Urban Informed Consent Organization & Administration Patient Selection Seroepidemiologic Studies Comparative Study Randomized Controlled Trial Research Support, N.i.h., Extramural Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Pharmacology (medical)

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
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