HIV Testing and Diagnosis of Emergency Department Patients New Jersey, 2005-2008 Charlotte Sadashige, MSS; Sindy

2. Nationally, NJ is one of 5 states with name-based reporting in 2008 that had an HIV/AIDS prevalence rate of 400 or greater.1 The Centers for Disease Control and Prevention estimates 1.2 million people are living with HIV in the United States. However, 200,000 Americans, or roughly one in five Americans living with HIV, have not been diagnosed and are not aware of their infection.2 The CDC recommends persons aged 13-64 years be screened for HIV in health-care settings as part of routine medical care to identify all HIV infected persons and to initiate early intervention.3 Voluntary rapid HIV testing through publicly funded Counseling and Testing Sites (CTSs) was implemented in New Jersey in 2003. Confirmatory Western blot testing is conducted at the NJ Department of Health & Senior Services’ Public Health and Environmental Laboratories in Trenton. Rapid HIV testing through publicly-funded CTSs is currently offered at over 70 sites including federally qualified health centers, community-based organizations, local health departments, mobile vans, prisons, and emergency departments. Nearly 100,000 tests are conducted annually.   Voluntary rapid testing at emergency departments was implemented in New Jersey in 2004 following the results of an HIV seroprevalence study in Newark which found 10% seropositivity. Forty percent (40%) of seropositive patients did not indicate a previous diagnosis and were reportedly unaware of their infection.   Publicly-funded rapid HIV testing is offered at 18 NJ EDs using Oraquick Advance® or STAT-PAK®. The availability of Food and Drug Administration (FDA) approved rapid HIV tests makes the ED a logistically feasible setting to offer HIV testing. HIV counseling and testing is integrated into patient care, and patients receive their preliminary HIV test result before leaving the ED. Nationally, NJ is one of 5 states with name-based reporting in 2008 that had an HIV/AIDS prevalence rate of 400 or greater.1 The Centers for Disease Control and Prevention estimates 1.2 million people are living with HIV in the United States. However, 200,000 Americans, or roughly one in five Americans living with HIV, have not been diagnosed and are not aware of their infection.2 The CDC recommends persons aged 13-64 years be screened for HIV in health-care settings as part of routine medical care to identify all HIV infected persons and to initiate early intervention.3 Voluntary rapid HIV testing through publicly funded Counseling and Testing Sites (CTSs) was implemented in New Jersey in 2003. Confirmatory Western blot testing is conducted at the NJ Department of Health & Senior Services’ Public Health and Environmental Laboratories in Trenton. Rapid HIV testing through publicly-funded CTSs is currently offered at over 70 sites including federally qualified health centers, community-based organizations, local health departments, mobile vans, prisons, and emergency departments. Nearly 100,000 tests are conducted annually.   Voluntary rapid testing at emergency departments was implemented in New Jersey in 2004 following the results of an HIV seroprevalence study in Newark which found 10% seropositivity. Forty percent (40%) of seropositive patients did not indicate a previous diagnosis and were reportedly unaware of their infection.   Publicly-funded rapid HIV testing is offered at 18 NJ EDs using Oraquick Advance® or STAT-PAK®. The availability of Food and Drug Administration (FDA) approved rapid HIV tests makes the ED a logistically feasible setting to offer HIV testing. HIV counseling and testing is integrated into patient care, and patients receive their preliminary HIV test result before leaving the ED.

3. HIV/AIDS Seroprevalence byCTS Site Type – New Jersey, 2005 - 2008 Four hundred six (6%) of 6,430 HIV/AIDS cases in New Jersey from 2005-2008 were diagnosed at emergency departments. The percentage of positive tests from emergency department CTSs during this time period was the highest among all CTS site types.   Four hundred six (6%) of 6,430 HIV/AIDS cases in New Jersey from 2005-2008 were diagnosed at emergency departments. The percentage of positive tests from emergency department CTSs during this time period was the highest among all CTS site types.  

4. Individuals with no health insurance often rely on emergency departments for their health care. Nearly 1.3 million (17%) non-elderly New Jerseyans were without health insurance in 2008.   Thirty-six percent (36%) of seropositive persons diagnosed at EDs had no health insurance compared with 17% among all HIV/AIDS diagnoses during this time period. Individuals with no health insurance often rely on emergency departments for their health care. Nearly 1.3 million (17%) non-elderly New Jerseyans were without health insurance in 2008.   Thirty-six percent (36%) of seropositive persons diagnosed at EDs had no health insurance compared with 17% among all HIV/AIDS diagnoses during this time period.

5. Percentage of Late ED Diagnoses –New Jersey, 2005 - 2008 Overall, 83 ED diagnoses were late (simultaneous HIV and AIDS diagnosis or an AIDS diagnosis <12 months from the initial HIV diagnosis). Seventy percent (70%) of those were men and 30% were women.   African Americans (77%) comprised the vast majority of late diagnoses by race/ethnicity compared with Hispanics (12%) and Whites (10%). Among the three major transmission categories (MSM, IDU, high risk Heterosexual contact), most (70%) late ED diagnoses occurred among persons exposed through high risk heterosexual contact followed by Male-Sex-with-Men (20%) and Intravenous Drug Use (10%).   Overall, 83 ED diagnoses were late (simultaneous HIV and AIDS diagnosis or an AIDS diagnosis <12 months from the initial HIV diagnosis). Seventy percent (70%) of those were men and 30% were women.   African Americans (77%) comprised the vast majority of late diagnoses by race/ethnicity compared with Hispanics (12%) and Whites (10%). Among the three major transmission categories (MSM, IDU, high risk Heterosexual contact), most (70%) late ED diagnoses occurred among persons exposed through high risk heterosexual contact followed by Male-Sex-with-Men (20%) and Intravenous Drug Use (10%).  

6. Conclusions HIV/AIDS prevalence among persons screened at CTS EDs was the highest by site type among all publicly-funded HIV counseling and testing sites. A higher percentage of patients diagnosed at EDs had no health insurance compared with all persons diagnosed with HIV/AIDS in New Jersey during the same time period. Disparities based on race/ethnicity and transmission category exist among persons diagnosed with HIV/AIDS late in their disease progression at EDs. HIV screening in EDs integrates HIV services into medical care, and may provide an efficient gateway to HIV prevention and care particularly for persons with limited access to health care and persons with a lower perception of HIV risk. Patients receive their preliminary HIV test result before leaving the ED. HIV/AIDS prevalence among persons screened at CTS EDs was the highest by site type among all publicly-funded HIV counseling and testing sites.   A higher percentage of patients diagnosed at EDs had no health insurance compared with all persons diagnosed with HIV/AIDS in New Jersey during the same time period.   Disparities based on race/ethnicity and transmission category exist among persons receiving an HIV/AIDS diagnosis late in their disease progression at EDs.   Expanded testing among emergency department patients is important to identify persons infected with HIV, particularly those with limited access to health care. Rapid HIV testing at EDs has the additional benefit that patients receive their preliminary HIV test result before leaving the ED.   HIV screening in EDs integrates HIV services into medical care, and may provide an efficient gateway to HIV prevention and care, particularly for persons with a lower perception of HIV risk, racial and ethnic minorities, persons not seeking HIV-specific services.  HIV/AIDS prevalence among persons screened at CTS EDs was the highest by site type among all publicly-funded HIV counseling and testing sites.   A higher percentage of patients diagnosed at EDs had no health insurance compared with all persons diagnosed with HIV/AIDS in New Jersey during the same time period.   Disparities based on race/ethnicity and transmission category exist among persons receiving an HIV/AIDS diagnosis late in their disease progression at EDs.   Expanded testing among emergency department patients is important to identify persons infected with HIV, particularly those with limited access to health care. Rapid HIV testing at EDs has the additional benefit that patients receive their preliminary HIV test result before leaving the ED.   HIV screening in EDs integrates HIV services into medical care, and may provide an efficient gateway to HIV prevention and care, particularly for persons with a lower perception of HIV risk, racial and ethnic minorities, persons not seeking HIV-specific services.