Rapid HIV Screening: Should it be included as a routine lab test in every Emergency Room in Maryland?

by

OraQuick HIV Test

HIV has plagued the lives of many Maryland state residents. In 2008, the MD Department of Health and Human Hygiene reported that approximately 29,021 individuals living in the City of Baltimore had HIV/AIDS. [1] This number has steadily increased!

In 2006, a team of physicians (led by Drs. Kelan and Rothman) and researchers from The Johns Hopkins Hospital obtained a government grant that enabled them to offer rapid HIV testing in the Emergency Room (ER). The OraQuick HIV-1 & -2 Antibody test was utilized and required the signed consent from the patient along with a simple mouth swab. Currently, this test is free because of government funding. Who will incur the bills once the existing grant funding has been depleted?

The usage of rapid HIV screening tools in the ER would allow patients and clinicians to obtain useful information about their HIV status during a routine examination. Many individuals would never seek an HIV test!  Early detection and diagnosis would give the patient time to “tap into” and utilize adequate treatment, education, and resources that would enable them to cope with their disease and obtain and maintain optimal health. Each Maryland state resident must join me in this fight against AIDS by contacting his/her local and state legislators, healthcare coalitions, insurance companies, and pharmaceutical companies to support the implementation of this sustainable policy that would grant funding and mandate the use of rapid HIV screening in all MD ERs. This measure would change the lives of many undiagnosed HIV MD residents!

Maryland State HIV/AIDS Statistics:

http://aids.about.com/od/statebystateresources/qt/maryland.htm

Maryland Department of Health & Mental Hygiene: [1]

http://www.dhmh.state.md.us/AIDS/Data&Statistics/statistics.htm

CDC Information:

http://www.cdc.gov/hiv/topics/testing/rapid/

http://www.cdc.gov/hiv/topics/testing/resources/qa/oralfluidqandafin.htm

The Johns Hopkins Hospital Related Article:

http://www.hopkinsmedicine.org/dome/0704/feature1.cfm

The Johns Hopkins Hospital Point of Care Technology HIV Guide:

Http://www.hopkins-aids/management/laboratory testing/full_hiv_diagnosis.html

For more information on the subject of HIV/AIDS Resources:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm

http://www.healthcareforall.com/HTML4.phtml

For information about OraQuick HIV testing protocol:

http://www.orasure.com/products-infectious/products-infectious-oraquick.asp

http://www.thebody.com/content/art17168.html

Advertisements

7 Responses to “Rapid HIV Screening: Should it be included as a routine lab test in every Emergency Room in Maryland?”

  1. ajonnal Says:

    Thank you for this informative and important posting. I was a resident in the Department of Emergency Medicine at Johns Hopkins in 2005 when our faculty were studying the feasibility of rapid HIV testing in the ED and it was a very exciting time. As the CDC does support this practice, I believe it is time to investigate the means to implement it more broadly in Maryland. A colleague of mine at the Emergency Department where I currently work is planning to do a pilot project there so that we can begin testing as well. I meet so many patients who are marginalized and do not interface with any medical establishment other than an Emergency Department; if they test positive, they could potentially get connected with needed health and social services immediately during their visit to our department. I strongly support this practice and feel that any additional costs or time required to initiate it would be well-spent, and possibly lead to reduced costs in caring for patients with advanced AIDS-related illnesses who did not know of their HIV status. Thank you.

  2. julierwan Says:

    I agree with you on this very important issue! As a former HIV test counselor, I used to believe that routine screening could be more harmful than useful if there was inattention to how the HIV status was documented in medical records, particularly in areas of informed consent, legal consequences for undocumented immigrants, and lack of counseling and health education in a busy PHC or ED setting. However, given the startling number of concurrent diagnosis of HIV and AIDS and high use of EDs for primary care in urban areas, routine testing can certainly help in early diagnosis of HIV and provide more time and opportunities for medical treatment and social support. In addition, the lift of the HIV travel ban is a great opportunity to reduce the fear surrounding HIV and deportation for non-US residents. Your proposal to routinize HIV screening in EDs can also have far reaching effects on reducing the stigma of HIV. If HIV is part of the routine medical assessment, like checking for hypertension and heart disease, then slowly, more people may be willing to get tested since they don’t have to ask for an additional test which they fear may raise questions and judgments from the medical providers and insurers. Even though the CDC supports routine HIV testing, it’s still up to each state to enact legislation to this effect, each ED to implement routine testing programs, and each provider and each patient to internalize the benefits.

  3. atukpah Says:

    This is a very important issue raised. According to the DOME / Hopkins article, 50% of HIV cases in Maryland originate in Baltimore City and about 1 million people in the United States do not know they are HIV positive. Having a rapid test offered as part of routing testing in the ER may help remove some of the fears associated with testing that prevent people from seeking out this vital service. I think it is also imperative that the test is confirmed and those who test positive are introduced to counseling immediately. Though it is cited as sometimes a barrier, ensuring that those who administer the test in the program are certified I believe is an important element in standardizing the protocol and approach. Identifying people early so their prognosis is better and so they do not unknowingly infect others is crucial and hopefully based on the results obtained from this pilot program more funding will become available. Making testing routine in the ER should also be considered part of the efforts for integrating HIV testing into all hospital/doctor/clinic care regimens, following the CDC recommendation for increasing voluntary testing in clinical practice.

  4. wysaw Says:

    HIV/AIDS has always been an area of interest for me, but to be honest with you, I was not very familiar with the distribution of cases in Maryland until I read your post. After I read your blog, I looked up statistics and was shocked to find that in 2008, Baltimore alone had one of the highest rates of new AIDS cases in the United States (http://www.avert.org/usa-states-cities.htm). A few years ago, I went through an 8-week-long clinical rotation in a Blood Bank. Sometime during those 8 weeks, I learned that some people who come in to “donate blood” during blood drives actually really want to just get tested for HIV since every specimen will get screened for it, all information is confidential and the testing is free, reducing the chances of HIV stigma. Since HIV/AIDS rates are highest in metropolitan areas where the majority of the population go to the ED for primary care, a rapid HIV screening mandate in all MD EDs is an excellent idea. People can be tested without the fear of being judged and labs that usually screen and test donor blood can work faster and more efficiently on specimens intended to be donated to people who need them. Of course, funding would be needed not just for the testing but for any follow-up treatment and other resources for those who may not be able to afford them.

  5. patgorres Says:

    I would fully support the implementation of a rapid HIV/AIDS test. Although people may recognize the prevalence and importance of their own HIV-status, I would suspect that most never make it past the contemplation stage, and do not actively seek tests for themselves, since there is a social stigma involved with the process. Standardizing the test takes all of that away, and I am sure patients would not mind obtaining their HIV-status alongside the other treatments they receive in the ER.

  6. oanimas1 Says:

    Hi Kathleen, it is interesting you brought this up. Knowing fully well that Baltimore and Maryland in general has one of the highest incidence and prevalence rate of HIV in the United States, it is very important to provide early screening to diagnose new cases. Rapid tests such as Oraquick are cost-effective and timely screens to effectively diagnose HIV infection.

    I think a lot of sensitization needs to be done on this issue. However, the issue of informed consent have posed some drawbacks to early detection. Individuals with at-risk sexual behaviour’s tend to decline HIV testing during ER visits in other to conceal their status if they already know or protect themselves from insurance woes.

    With continuous HIV education and counselling, HIV screening in ERs would become a norm and continuous funding for this surveillance strategy would become a necessity. Hence, more provisions should be made to ensure the sustainability of this method of controlling HIV incidence in Maryland.

  7. Dnevni boravci Says:

    Ugradbeni ormari…

    […]Rapid HIV Screening: Should it be included as a routine lab test in every Emergency Room in Maryland? « SBFPHC Policy Advocacy[…]…

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


%d bloggers like this: