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An Added Value of Rapid Testing: Improved Quality of Care

In a retrospective study, rapid HIV testing in the emergency department offered several advantages over conventional testing in the inpatient setting.

During the past several years, the CDC has promoted routine HIV testing through its campaign, "Advancing HIV Prevention: New Initiatives for a Changing Epidemic." At the same time, the field of HIV testing has been driven forward by the FDA’s approval of rapid HIV testing, which uses oral fluid and/or fingerstick and offers preliminary results within 20 minutes. As part of its campaign, the CDC has supported numerous demonstration projects aimed at evaluating the feasibility and value of rapid testing. In one such program at a Chicago hospital, rapid testing was available in the emergency department (ED) either routinely (during limited hours, in some ED locations) or by referral. Researchers retrospectively compared the outcomes of patients who were diagnosed via rapid HIV testing in the ED before admission with those of patients who were diagnosed via conventional testing after admission.

During the 17-month study period, 103 patients had a new diagnosis of HIV. Despite the availability of a "routine" program in the ED, fewer than half of the new diagnoses (47%) were made there; most were made in the inpatient setting using standard EIA/Western blot techniques. Although the two groups of patients had similar demographics, HIV risk factors, and other clinical characteristics, they differed in their utilization of care. Patients diagnosed with HIV infection in the ED setting versus the inpatient setting had significantly faster chart documentation of HIV infection (mean, 0.8 vs. 6.4 days), shorter length of stay (mean, 6.4 vs. 13.2 days), and more rapid HIV-outpatient follow-up (mean, 21.5 vs. 49.5 days). All patients diagnosed in the ED setting were told of their HIV diagnosis before discharge, compared with only 84% of those diagnosed in the inpatient setting. In multivariate analyses, conventional HIV testing, admission to the intensive care unit, and diagnosis with an opportunistic infection were all important independent predictors of a longer hospital stay.

Comment: Evidence continues to emerge to support increased HIV testing in high-prevalence areas. HIV counseling, testing, and referral programs in urgent care centers and EDs have proven that routine HIV testing is both feasible and effective for case identification. Recent studies defend the cost-effectiveness of HIV testing interventions, and the present study provides further support for rapid testing in particular. These results suggest that earlier HIV diagnosis limits unnecessary delays and interventions that may occur when the diagnosis is not yet established; the findings also demonstrate how rapid testing can improve resource use and quality of care.

— Rochelle P. Walensky, MD, MPH

Dr. Walensky is Assistant Professor of Medicine at Harvard Medical School in Boston.

Published in Journal Watch HIV/AIDS Clinical Care October 26, 2005

Citation(s):

Lubelchek R et al. The role of rapid vs conventional human immunodeficiency virus testing for inpatients: Effects on quality of care. Arch Intern Med 2005 Sep 26; 165:1956-60.

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