1. HIV Screening in an Urban Emergency Department The 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 1/05 - 2/06 Number tested6,283 Number Reactive Tests / Preliminary Positive 84 (1.3%) Confirmed Positives82 (98%) Number False Positives2 (2%) False Negatives1 (.016%) Number Linked to Care and Treatment Services 68/82 (83%)

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