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HIV Screening in an Urban Emergency Department The Highland Hospital Experience

HIV Screening in an Urban Emergency Department The Highland Hospital Experience. Douglas White, MD Alameda County Medical Center - Highland Hospital Oakland, CA. Scope of the Problem. Scope of the Problem in U.S. >1,000,000 people in U.S. with HIV/AIDS 25% unaware

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HIV Screening in an Urban Emergency Department The Highland Hospital Experience

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  1. HIV Screening in an Urban Emergency DepartmentThe Highland Hospital Experience Douglas White, MD Alameda County Medical Center - Highland Hospital Oakland, CA

  2. Scope of the Problem

  3. Scope of the Problem in U.S. • >1,000,000 people in U.S. with HIV/AIDS • 25% unaware • 40,000 new HIV infections/year • Barriers to testing • Accessibility, fear, confidentiality, cost • 30% people testing positive do not return for their results

  4. Why rapid HIV testing? • Increase testing rates • More people learn results • Enables testing in non-traditional settings • Emergency Departments • Outreach • Private homes

  5. Highland Hospital • Urban, academic, teaching hospital • Emergency Department • Regional trauma center • Emergency Medicine Residency • 70,000 patient visits/year • Diverse and Indigent patient population • Staff 120 nurses

  6. Highland Project Overview • Feasibility Study • CDC-funded, 2 year • Nursing-initiated HIV screening at triage • Routinely offer HIV testing to all eligible patients • Consent, testing, result disclosure (negatives) performed by nursing staff • ED physicians disclose preliminary positive • Streamlined testing and counseling protocol

  7. Bedside Testing Oraquick ADVANCE HIV-1/2

  8. Project Results - Basic Counts

  9. Results - Patient Satisfaction Newly Diagnosed Positives • 96% rated experience as good - excellent • 4% rated it as poor

  10. Conclusion • Routine, voluntary HIV screening in an urban ED using indigenous staff is feasible • Rapid testing with OraQuick ADVANCE using oral fluid is easy to perform • 120 nurses with minimal training • The rapid test performance was in accordance with manufacturer’s reported accuracy • Patient satisfaction is high

  11. OTC Application • Many barriers still exist when seeking HIV testing • Accessibility • Stigma/fear • Informed Consent • Counseling • Internal Resources • An OTC test would provide the public with more HIV testing options

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