Targeted screening not superior to nontargeted screening for human immunodeficiency virus in the emergency department

1. Targeted versus nontargeted HIV screening in the emergency department resulted in a similar number of new HIV diagnoses, yet a lower percentage of testing was performed in the targeted cohorts.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Diagnosing HIV is a critical public health priority to initiate early treatment and reduce spread from unaware individuals. This randomized clinical trial compared targeted and nontargeted HIV screening strategies in emergency departments (EDs). Patients were randomized to receive nontargeted HIV screening, enhanced targeted HIV screening (using an externally validated HIV prediction score called Denver HIV Risk Score [DHRS]), or traditional targeted HIV screening (using the Behavioural Risk Screening Tool [BRST]). This study was conducted on patients presenting to one of four EDs in Baltimore, Maryland, between April 2014 and January 2016. The primary outcome was new HIV diagnoses. In the nontargeted screening group, 6744/25 649 (26.5%) completed testing, of which 10 (0.15% [95% CI: 0.07-0.27]) were newly diagnosed with HIV. In the enhanced targeted screening, 13 883/25 453 (54.5%) had increased risk and 4488/13 883 (32.3%) completed testing; there were 7 (0.16% [95% CI: 0.06-0.32] new HIV diagnoses. In the traditional screening cohort, 7099/25 639 were deemed high-risk and 3173/7099 completed testing; there were 7 (0.22% [95% CI:0.08-0.45]) new HIV diagnoses. Among patients in the targeted cohorts, a lower percentage of HIV tests were performed (7661 [15.0%] versus 6744 [26.5%]; difference: 11.5% [95% CI: 10.9-12.1]; p< 0.001). Overall, when comparing targeted versus nontargeted screening, there were no significant differences in new HIV diagnoses, yet a significantly reduced percentage of HIV tests were performed in the targeted screening cohorts. One limitation of this study, however, is that among all total eligible ED visits in this study, greater than 50% were excluded for a variety of reasons.

Click to read the study in JAMA Network Open

Relevant Reading: Randomized comparison of universal and targeted HIV screening in the emergency department

Image: PD

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