HIV testing in emergency rooms a 'missed opportunity'
One-third of all South African adults evade the testing net, say researchers
A team who conducted HIV tests in a hospital emergency department diagnosed a new infection every day.
Now the doctors who led the project say testing should be implemented universally in emergency rooms to help South Africa tackle the world’s largest HIV epidemic.
However, they say the approach they used in 2016 at Frere Hospital in East London — where each test took between 30 and 40 minutes due to the amount of counselling involved — is not practical.
They were able to approach less than a quarter of the 9,583 patients who arrived at the emergency department between September 1 and November 30, and tested only 1,714 people. Of those, 115 were diagnosed with HIV for the first time.Writing in the journal PLOS One, the researchers said South Africa recorded 270,000 new HIV infections in 2016, but a third of all adults had evaded the testing net.
This was because testing was concentrated on primary healthcare clinics and antenatal clinics, meaning young men were not catered to.
“Only 59% of males have ever been tested compared to 71.5% of females,” said the researchers, who were led by David Stead of the Walter Sisulu University department of medicine, and Bhakti Hansoti of the Johns Hopkins University School of Medicine in Baltimore, US.“This gender discrepancy in testing in part leads to only 43% of HIV-positive males being engaged in care compared to 60% of females.”
Recent HIV-testing initiatives had targeted high-risk groups such as prisoners, sex workers and injecting drug users. “One segment of the population who are unlikely to interact with the healthcare system ... are young men.”
Even though 2015 HIV testing guidelines mandated universal testing in all healthcare facilities, it was not routinely implemented in emergency rooms. This was “a missed opportunity”, said Stead and Hansoti.
“Frequently cited barriers ... include limited time, inadequate resources and concerns regarding the provision of follow-up care.”They said the responsibility for universal HIV testing should be given to existing medical staff in emergency rooms.
“Our study demonstrated that a targeted testing approach by gender, presenting complaint, or the presence of TB symptoms, would miss many of the patients we captured with undiagnosed HIV infection.
“Further innovation and implementation research is required to develop a sustainable testing strategy integrated into the clinical environment.”