Emergency Department Could Fill Gaps in HIV Diagnoses

Current estimates suggest that 19% of South Africans are HIV-positive, making it the country with the highest prevalence of HIV. Despite improved testing practices in this region and worldwide, many individuals with HIV remain undiagnosed.

In an attempt to improve HIV diagnoses, researchers in a study published by PLOS ONE tested patients visiting the emergency department (ED) in South Africa. The study was conducted for 3 months in 2016 in the Eastern Cape of the country.

"This is a low resource area without electronic medical records or a patient track board to monitor patient status, and thus conducting research here is inherently difficult. Furthermore, patients come from a 60-mile radius and there are challenges to providing follow-up care," said researcher Bhakti Hansoti, MBChB, PhD. "In many low resource settings, the emergency department is a safety net for patients who are often missed by the health system."

The researchers noted that they were able to reach a high volume of unique and vulnerable patients by including this population.

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The authors trained hospital staff on the importance of HIV testing and how to approach patients, administer tests, and record findings.

Included in the study were 2355 patients visiting the ED who were offered HIV testing. Approximately 73% of these patients accepted testing and 22% tested positive for HIV. Only 6% of patients were newly-diagnosed, according to the study.

The researchers discovered that women were twice as likely to be diagnosed with HIV than men, with 1 in 3 women diagnosed, according to the study.

"As a region, the Eastern Cape has one of the highest rates of HIV infection in the world," said senior author Thomas Quinn, MD. "This particular study is the first to document the full magnitude of HIV infection in the region, and the eagerness of the people to know whether they are infected with HIV. The government provides access to treatment, making diagnosis a critical component of care."

Due to the time-consuming nature of HIV testing, the staff were only able to approach 1 in 4 ED patients, according to the study. The authors said that HIV self-testing and implementation research is crucial for creating a sustainable testing strategy for the ED.

The authors hope that testing vulnerable populations in the ED may become standard practice in the ED.

"We're transitioning emergency care from a service focused only on stabilization and resuscitation to a health care venue that helps a difficult-to-reach population with preventative care and surveillance, such as HIV testing," Dr Hansoti said. "It's time for a major paradigm shift for many hospitals and health systems as we define the role of emergency care in low resource environments."