• Yu-Hsiang Hsieh, Richard E Rothman, David E Newman-Toker, and Gabor D Kelen.
• Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA. yhsieh1@jhmi.edu
• AIDS. 2008 Oct 18;22(16):2127-34.

ObjectiveThe 2006 Centers for Disease Control and Prevention recommendations place increased emphasis on emergency departments (EDs) as one of the most important medical care settings for implementing routine HIV testing. No longitudinal estimates exist regarding national rates of HIV testing in EDs. We analyzed a nationally representative ED database to assess HIV testing rates and characterize patients who received HIV testing, prior to the release of the 2006 guidelines.DesignA cross-sectional analysis of US ED visits (1993-2005) using the National Hospital Ambulatory Medical Care Survey was performed.MethodsPatients aged 13-64 years were included for analysis. Diagnoses were grouped with Healthcare Cost and Utilization Project Clinical Classifications Software. Analyses were performed using procedures for multiple-stage survey data.ResultsHIV testing was performed in an estimated 2.8 million ED visits (95% confidence interval, 2.4-3.2) or a rate of 3.2 per 1000 ED visits (95% confidence interval, 2.8-3.7). Patients aged 20-39 years, African-American, and Hispanic had the highest testing rates. Among those tested, leading reasons for visit were abdominal pain (9%), puncture wound/needlestick (8%), rape victim (6%), and fever (5%). The leading medication class prescribed was antimicrobials (32%). The leading ED diagnosis was injury/poisoning (30%) followed by infectious diseases (18%). Of note, 6% of those tested were diagnosed with HIV infection during their ED visits.ConclusionPrior to the release of the 2006 Centers for Disease Control and Prevention guidelines for routine HIV testing in all healthcare settings, baseline national HIV testing rates in EDs were extremely low and appeared to be driven by clinical presentation.

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