# Presentation: 840708

## Rapid HIV Testing in an Emergency Department

- Cook County Bureau of Health Services
- Chicago, Illinois
- Centers for Disease Control
- and Prevention
- (Cooperative Agreement  #CCU516455)

## Study Objectives

- Determine if rapid HIV testing (RT) is feasible and acceptable in a busy urban hospital emergency department (ED)
- Assess patient receipt of results
- Evaluate patient entry into care following a positive rapid HIV test

## Study Methods

- Eligibility criteria
- Age 18 - 60
- Informed consent
- Study staff on site
- Counseling
- Pre & post-test script based on CDC 3/98 recommendation
- HIV+ pts scheduled for evaluation when receive results

- Rapid test device
- SUDS HIV- 1 Test, Abbott/Murex
- Positive SUDS tests repeated in duplicate
- All SUDS tests supplemented with EIA
- WB performed on all SUDS+ and EIA+

##  Cook County Hospital Emergency Department

- Busiest emergency department in Chicago
- 120,000 patient visits/year
- January 2001 conventional HIV testing
- June 2001 rapid HIV testing

## CCH-ED Procedure Conventional HIV Testing (CT)

- ED providers perform pre-test counsel and obtain informed consent
- Blood drawn by ED nurse
- Specimen sent to hospital lab for EIA
- Patient directed to the CORE Screening Clinic for results in two weeks

## Rapid Test Study ED Procedure

- 	Three health educators responsible for:
- 	Pre-test counseling
- 	Obtaining written informed consent
- 	Phlebotomy
- 	Rapid testing
- 	Result/Post-test counseling

## Rapid Test AcceptanceJune – December 2001

- Pts approached
- 5964

- Pts eligible
- 5095 (85%)

- Pts accepted RT
- 1365 (27%)

## Receipt of results:  RT vs CTJanuary – December 2001

|  | Rapid
Testing | Conventional 
Testing |
| --- | --- | --- |
| Pts. tested | 1365 | 144 |
| Pts. received results | 
1355  /  99.3%      | 
  34  /  24% |
| Time to 
receive results | 
< 2 hours | 
14.5 days |

## Counseling,Testing, Results Mean times (minutes)

|  | Pretest
Counsel | SUDS
Testing | Result
to Patient | 
Total |
| --- | --- | --- | --- | --- |
| SUDS
Negative
(N=1303) | 
  12.6 | 
  30.3 | 
    1.4 | 
  44.2 |
| SUDS
Positive
(N=36) | 
  14.4 | 
  43.0 | 
  35.9 | 
  94.1 |

## Entry to Care: RT vs CTJanuary – December 2001

|  | Rapid 
Testing | Conventional
Testing |
| --- | --- | --- |
| Pts. tested | 1365 | 144 |
| Pts. positive |     36  (2.6%) |   13  (9%) |
| Pts. entered care |     30  (83%) |   10  (77%) |
| Median days test to visit |     13.5 
   (range 4-113) |   26.5
  (range 10-319) |

## SUDS PerformanceN=1365

- Sensitivity	100.0%
- Specificity   	  99.8%
- PPV 		  92.3%
- NPV		100.0%
- Accuracy 	  99.8%

## Conclusions

- Rapid HIV testing was well received by many patients
- Point-of-care rapid HIV testing in the ED is feasible
- Rapid testing increases the number of people who learn their results and may improve entry into care

## Rapid HIV Study

- Robert A. Weinstein, MD, Principal Investigator
- Sabrina R. Kendrick, MD, Co-Principal Investigator
- David Withum, Dr.PH, CDC, Co-Investigator
- Bernard Branson, MD, CDC, Co-Investigator
- Eileen Couture, DO, Site Investigator
- Shayle Miller, MD, Site Investigator
- Rovonda Doty, Health Educator
- Regina Harden, Health Educator
- Bernice Wilson, Health Educator
- Carole Marsh, Data Entry