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A 63-year-old construction worker came to the ED at Jacobi Medical Center in Bronx, NY, with difficulty swallowing, and reported losing 40 pounds in the previous six months. He tested positive for human immunodeficiency virus (HIV), and was seen at the hospital's clinic the same day. "His CD4 is now more than 400, he has gained 40 lbs. back, and is able to do his construction work," says Jason M. Leider, MD, PhD, associate professor of clinical medicine.
More than 60,000 of the ED's patients have been tested since October 2005, using a new rapid HIV test (INSTI, manufactured by Vancouver, Canada-based bioLytical Laboratories), and more than 200 tested positive.
The rapid HIV testing is offered to all ED patients at Jacobi Medical Center, performed by public-health advocates (PHAs), with video counseling done with the use of portable personal computers, reports Leider.
If one of the ED's patients tests positive, the PHAs make sure that he or she is immediately referred to the hospital's HIV clinic. "This allows ED nurses to work unimpeded," says Leider. "They simply encourage patients to get tested, and then have the PHAs work with the patients."
"Our nurses could not be happier, as they achieve a major health-care objective without hampering their other duties," he says.
Rapid testing is a screening tool with very high sensitivity and specificity, says Leider. "It can tell patients who test negative, with high certainty, that they are truly negative," he says. "For patients testing positive, further confirmatory testing is needed."
Rapid HIV testing in the ED can identify patients who are unknowingly infected and are transmitting the infection, says Leider. "Such patients account for about 20% of all those who are infected, yet account for 50%-75% of transmissions," he says.
In the ED, there is a "golden moment of learning," says Leider. "It is quite hard to calculate the long-term impact of counseling on risk-reduction behavior," he says. "But it is our firm belief that if HIV counseling can be seamlessly woven into the fabric of ER medical care without impeding the flow, then it should be done."
For more information on rapid HIV testing in the ED, contact:
Jason M. Leider, MD, PhD, Department of Medicine, Jacobi Medical Center, Bronx, NY. Phone: (718) 918-3669. Fax: (718) 918-7686. E-mail: email@example.com