Comparable Rates of HIV Diagnoses With Targeted and Nontargeted Screening

Targeted and nontargeted human immunodeficiency virus (HIV) screening in emergency departments led to similar rates of new HIV diagnoses, yet targeted strategies required significantly fewer tests. Researchers published findings from their randomized trial online in JAMA Network Open.

“Notably, all three screening strategies exceeded the 0.1% HIV test prevalence threshold for performing routine screening as suggested by the Centers for Disease Control and Prevention (CDC) and supported by cost analyses,” researchers wrote. “Furthermore, relatively small proportions of newly diagnosed patients were AIDS-defined at the time of diagnosis, suggesting the benefits of screening to prevent late diagnosis, and the majority of patients had improved CD4 cell counts and viral loads 1 year after diagnosis.”

For the study, 76,561 patients visiting emergency departments at four US urban hospitals underwent concealed randomization to one of three strategies: (1) nontargeted screening; (2) enhanced targeted screening using a quantitative HIV risk prediction tool; and (3) traditional targeted screening as adapted from the CDC.

Among 25,469 patients randomized to nontargeted screening, 6744 completed testing and 0.15% were newly diagnosed with HIV. Among 25,453 patients allocated to enhanced targeted screening, 13,883 met risk criteria, 4488 completed testing, and 0.16% were newly diagnosed. Among 25,639 patients in the traditional targeted group, 7099 met risk criteria, 3173 completed testing, and 0.22% were newly diagnosed.

Targeted screening strategies were not associated with a higher rate of new diagnoses compared with the nontargeted screening, the study showed.

“Despite not identifying a clearly superior approach, this trial does support the importance of routine screening for HIV in emergency departments,” researchers wrote. “Although the overall number of new HIV diagnoses was low, the individuals who were diagnosed through screening efforts were able to start antiretroviral therapy and improve their health and, very likely, to avert transmissions. These actions would not have been possible without an HIV diagnosis.”

Reference:

Haukoos JS, Lyons MS, Rothman RE, et al. Comparison of HIV Screening Strategies in the Emergency Department: A Randomized Clinical Trial. JAMA Netw Open. 2021;4(7):e2117763. Published 2021 Jul 1. doi:10.1001/jamanetworkopen.2021.17763