Hospital ER Provides Effective HIV Testing to High-Risk Patients

An HIV-testing program at University Hospital’s emergency department could provide a national model for effective screening of 110 million emergency department patients a year, and put a serious dent in the spreads of AIDS.

Although emergency departments often see patients with HIV risk factors, they lack the resources to provide HIV testing. That’s where University Hospital’s HIV Early Intervention Program can make a difference.

A collaboration involving the UC Academic Health Center and Cincinnati Health Network, and funded by Ohio Department of Health, the program identified 45 HIV-positive patients at the hospital from Jan. 1, 1999, through Dec. 31, 2002. All were counseled and referred for treatment and disease-prevention education.

“Emergency departments can play an important role in stopping the spread of infectious diseases if they have health department resources to work with,” explains Michael Lyons, MD, assistant professor of emergency medicine at UC College of Medicine. “Ohio Department of Health’s support has enabled us to develop a program that wouldn’t be possible elsewhere.

“Applying this health department/ER partnership model to the 110 million ER visits in the United States each year could lead to rapid changes in public health in our country in terms of HIV detection,” he says. “It could also provide a model for addressing other public health issues such as immunization and patient education.”

Dr. Lyons is the lead author of an article published in the May–June issue of the journal Public Health Reports that details how public health programs in academic/hospital emergency departments can effectively detect and help prevent the spread of infectious diseases.

UC emergency department physicians, nurses and specially-trained counselors began HIV testing and counseling at University Hospital seven years ago. The hospital’s emergency department sees more than 85,000 patients a year and provides medical care for a large proportion of uninsured and medically indigent patients in the Greater Cincinnati area.

Dr. Lyons and his team studied counseling and testing data at the five sites funded by Ohio Department of Health in Hamilton County. They found that 5,232 of the 26,382 patients tested were seen at University Hospital’s emergency department.

The study showed that although University Hospital’s emergency department program accounted for 19.8 percent of all tests, it identified 24.7 percent of all HIV-positive patients.

Despite the fact that emergency services are often considered a high-cost option for medical care, Dr. Lyons points out, the actual cost per positive HIV test in the emergency department was 9 percent cheaper than at community health centers.

“An urban, academic teaching hospital setting and about $100,000 per year in support from public funds for testing and counseling make the program at University Hospital unique,” he says.

The study also revealed that hospital emergency department patients were more likely to consent to HIV testing than those using community clinics.

Co-author Christopher Lindsell, PhD, of UC’s Institute for the Study of Health, explains: “It’s much simpler to say yes to a test when you’re already in the ER, than to go to a clinic and request the test yourself. Because of this collaboration, we’re able to test people who wouldn’t normally be tested.

“More important,” he added, “by identifying HIV-positive patients who probably wouldn’t have been tested without our program, we’re cost-effectively preventing further transmission of the disease. And we’re also able to test a high-risk population without the cost of finding these people elsewhere in the community.”

Testing in the emergency department has another significant advantage, Dr. Lindsell points out.

“Emergency room patients have often taken a risk that has caused illness or injury,” he explains. “However, studies show that people with one risky behavior may take risks in other areas of their life, such as sexual or other lifestyle choices, that can increase the risk of HIV infection.”

Patients who test positive during emergency department screening receive free counseling at University Hospital and are referred to UC’s Infectious Disease Center, where they learn how they can help control the virus and slow the progression to AIDS.

The program also received funding through Cincinnati Health Network, a local homeless advocacy group that works with the Ryan White Foundation to provide HIV-tests for the medically indigent. The foundation is named after a hemophiliac Indiana boy who died after becoming HIV-positive from blood collected before today’s testing standards were available.