Objectives
The purpose of this study is to determine the occurrence of HIV infection among adults aged 8-60 who present themselves for care to the ED at Franklin Square Hospital by testing for serum HIV antibodies. The study will also identify adults with HIV infection who are not receiving care and refer these patients for primary and HIV care. Formal education will be conducted to teach Family Medicine residents in the design, conduct, and analysis of a community-based research study as well as provide free HIV serum antibody testing to uninsured adults presenting for ED care.
Rationale
The rationale behind this study is that the CDC has recommended an HIV screening in ED settings to be considered in areas where the prevalence of HIV infection exceeds 0.3-0.4% (300-400/00,000). The ED at FSH may consider offering HIV screening if the prevalence warrants it. In addition, HIV-infected adults may not know where the prevalence warrants it. We will also base this work on the rationale that, persons who know they are HIV infected change behaviors to reduce transmission. The CDC is also making an effort to include all 50 states in HIV surveillance with 0-25% of patients who test positive reporting no high-risk behaviors.
Literature review
health departments continue to look for ways to enhance their HIV prevention portfolios (Silva, et al. 2007). This includes identifying policies to strengthen HIV screening and counseling programs to increase their effectiveness in identifying persons who have undiagnosed HIV infection and linking them with care and treatment. Therefore, EDs and other urgent care facilities are of particular interest since they are high-volume facilities, serve persons who may not seek health care in other venues and they do not routinely recommend or offer HIV testing. With the recent publication of the CDC on revised recommendations for HIV testing of adults, adolescents and pregnant women in
health care settings, interest in screening HIV in EDs has intensified among health departments, federal agencies, and among EDS. The National Alliance of State and Territorial AIDS Directors (NASTAD) convened in 2007 to give the green light on the implementation of HIV testing in EDs (Silva, et al. 2007). Many institutions have added their voices in calling for HIV routine screening to adults and adolescents regardless of perceived risk. The CDC calls for the screening of all adults and teenagers where the prevalence is high. A recent study indicated that ED utilization among HID-positive adults in the AART era was associated with a considerable low-income level and greater mean viral load (Guss, 994). However, centers in high prevalence regions are associated with problems such as lack of knowledge of underlying HIV status and lack of access to clinical resources to manage the HIV infections (Talan & Kennedy, 99). Health departments have reported several factors that led to a critical examination of HIV counseling and testing services. Some of the underlined factors include; epidemiological data, blinded seroprevalence surveys, data of individuals who know they are HIV infected and they are not in care as well as constrained funding issues. Health departments and EDs recognize the importance of clinical and prevention benefits of HIV screening in the EDs. However, the extent to which the implementation of HIV screening is feasible is not entirely clear. Screening programs may be difficult in situations where high numbers of patients are seen in EDs. In addition, in high prevalence areas where a large number of patients with undiagnosed HIV infection may be seen in EDs, the practicability of screening is challenging due to the intensity and amount of effort that may be required for patient follow up and assistance to facilitate healthy medical care (Lyons, et al. 2005).
Reasons for carrying out the research