{"id":19304,"date":"2023-04-10T08:00:50","date_gmt":"2023-04-10T08:00:50","guid":{"rendered":"https:\/\/clinlabint.com\/?p=19304"},"modified":"2023-04-07T11:47:06","modified_gmt":"2023-04-07T11:47:06","slug":"targeted-testing-for-hiv-in-hospital-emergency-departments-has-great-potential-spanish-researchers-say","status":"publish","type":"post","link":"https:\/\/clinlabint.com\/targeted-testing-for-hiv-in-hospital-emergency-departments-has-great-potential-spanish-researchers-say\/","title":{"rendered":"Targeted testing for HIV in hospital emergency departments has great potential, Spanish researchers say"},"content":{"rendered":"<div id='av_section_1'  class='avia-section main_color avia-section-default avia-no-border-styling  avia-bg-style-scroll  avia-builder-el-0  avia-builder-el-no-sibling   container_wrap fullsize' style=' '  ><div class='container' ><main  role=\"main\" itemprop=\"mainContentOfPage\"  class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-19304'><div class='entry-content-wrapper clearfix'>\n<div class=\"flex_column av_one_fifth  av-hide-on-mobile  flex_column_div av-zero-column-padding first  avia-builder-el-1  el_before_av_three_fifth  avia-builder-el-first  \" style='border-radius:0px; '><section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock  '   itemprop=\"text\" ><p style=\"text-align: center\"><!--Begin ClixTrac.com Banner Code -->\r\n<a href=\"https:\/\/clixtrac.com\/goto\/?311442\" target=\"_blank\" rel=\"noopener\"><img decoding=\"async\" src=\"https:\/\/clixtrac.com\/banner\/311442.jpg\" alt=\"Bio-Rad - Preparing for a Stress-free QC Audit\" title=\"Bio-Rad - Preparing for a Stress-free QC Audit\" border=\"0\" \/><\/a>\r\n<!--End ClixTrac.com Banner Code --><\/p>\n<\/div><\/section><\/div><div class=\"flex_column av_three_fifth  flex_column_div av-zero-column-padding   avia-builder-el-3  el_after_av_one_fifth  el_before_av_one_fifth  \" style='border-radius:0px; '><section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock  '   itemprop=\"text\" ><p style=\"text-align: center\"><\/p>\n<\/div><\/section><br \/>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock  '   itemprop=\"text\" ><header class=\"entry-content-header\"><h1 class=\"post-title entry-title\" itemprop=\"headline\">Targeted testing for HIV in hospital emergency departments has great potential, Spanish researchers say<\/h1><span class=\"post-meta-infos\">\/ <span class=\"blog-categories minor-meta\">in <a href=\"https:\/\/clinlabint.com\/e-news\/\" rel=\"tag\">E-News<\/a> <\/span><\/span><\/header>\n<\/div><\/section><br \/>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock  '   itemprop=\"text\" ><ul>\n<li>\n<h3><i><span lang=\"EN-US\">Strategy led to number of HIV diagnoses increasing more than three-fold<\/span><\/i><\/h3>\n<\/li>\n<li>\n<h3><i><span lang=\"EN-US\">Implemented country-wide, it would prevent 13,615 new infections and save \u20ac4,411 million in healthcare costs in two decades<\/span><\/i><\/h3>\n<\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p><em><b>Note: the release below is a special early release from the European Congress of Clinical Microbiology &amp; Infectious Diseases (ECCMID 2023, Copenhagen,<\/b> <b>15-18 April<u>)<\/u>.<\/b><\/em><\/p>\n<p><span lang=\"EN-US\">Targeted testing for HIV in emergency departments has great potential for increasing diagnoses,<\/span>this year\u2019s European Congress of Clinical Microbiology &amp; Infectious Diseases (ECCMID) in Copenhagen, Denmark, (15-18 April), will hear.<\/p>\n<p>An analysis of data from 34 emergency departments (ED) in Spain found that the number of HIV diagnoses more than trebled after targeted testing was implemented.<\/p>\n<p><span lang=\"EN-US\">Researcher Dr Juan Gonz\u00e1lez del Castillo, head of the Infectious Disease Group of Spanish Emergency Medicine Society (SEMES), says: \u201cEarly diagnosis is key to avoiding the spread of HIV infection and improving patients\u2019 prognosis but rates of undiagnosed and late-diagnosed infections are still high.<\/span><\/p>\n<p><span lang=\"EN-US\">\u201cAn estimated 20% of infected people globally do not know they are living with HIV and late diagnosis rates are close to 50% in the developed world. In Spain, the figure is 48%.<\/span><\/p>\n<p>\u201cScreening for HIV in hospital emergency departments could increase the number of diagnoses, as well as allow more cases to be detected earlier.\u201d<\/p>\n<p>Guidance released by SEMES in 2021<sup>1,2<\/sup><b><i> <\/i><\/b>recommends the promotion of HIV testing and referral to appropriate specialists for follow-up in individuals attending emergency departments (ED) for treatment related to one of six conditions or behaviours: sexually transmitted infections (STI), mononucleosic syndrome (MN), herpes zoster virus (HZ), community-acquired pneumonia (CAP), practice of chemsex (CS) and HIV post-exposure prophylaxis (PEP).\u00a0 These are common in people with HIV and are also frequently seen in ED.<\/p>\n<p>In this longitudinal study, Dr Gonz\u00e1lez del Castillo, head of the emergency department at Hospital Cl\u00ednico San Carlos, Madrid, Spain, and colleagues used administrative data and medical charts from 34 Spanish EDs (13% of the national network) participating in theDejatuhuella (Leave your mark) programme to evaluate levels of HIV testing before (July-Dec 2019) and after (Jan to June 2022) the SEMES guidance was implemented.<\/p>\n<p>The number of HIV tests ordered in ED increased from 7,080 to 13,436.\u00a0 This represents an increase of 75%, when differences in the number of people attending ED are taken into account.<\/p>\n<p>The number of HIV diagnoses increased more than three-fold, from 65 to 224.\u00a0 This represents an increase of 220%, when ED attendance figures are factored in.<\/p>\n<p>The positive test rate increased from 0.92% to 1.67%.\u00a0 This was expected, as previous studies had shown a high positive rate in the six conditions and behaviours covered by the SEMES recommendations.<\/p>\n<p>There was a significant increase in HIV testing in all of the recommended areas, apart from practice of chemsex.\u00a0 STI (36% of patients tested for HIV before implementation vs. 67% after implementation), MS (27% vs. 51%), CAP (7% vs. 21%), HZ (6% vs. 29%), PEP (68% vs 83%).\u00a0 The rate of HIV in CS remained unchanged at 78%.<\/p>\n<p>The demographic and health characteristics of the individuals diagnosed in both periods were similar.<\/p>\n<p>There was a significant reduction in the time between ED attendance and the first appointment with an HIV specialist (median of 30 days vs. 7 days), as well as the initiation of antiviral treatment (median of 24 days vs.14 days).<\/p>\n<p>The study\u2019s authors conclude that the implementation of targeted testing for HIV in emergency departments led to a significant increase in HIV diagnoses.<\/p>\n<p>To date, a total of 103 EDs have implemented the recommendations.\u00a0 Data from SEMES shows that <span lang=\"EN-US\">in 2021 and 2022, 113,030 tests were performed, with 287 HIV diagnoses in 2021 and 601 in 2022 \u2013888 new diagnoses in these two years.<sup>3<\/sup>\u00a0 (It isn\u2019t possible to make comparison with earlier years.)<\/span><\/p>\n<p><span lang=\"EN-US\">If it is assumed that one diagnosis prevents another two to four cases, the new diagnoses in these two years will have led to 1,756 to 3,512 new cases being avoided.<sup>3<\/sup><\/span><\/p>\n<p>Dr Gonz\u00e1lez del Castillo says: \u201cWe really hope that the Dejatuhuella programme will reverse the downward trend in HIV diagnoses in Spain and reduce the spread of HIV and the high rates of late diagnosis.<\/p>\n<p>\u201cEDs could play a crucial role in HIV diagnosis. We know from previous research that one in three missed opportunities to diagnose HIV occurs in ED and we also know that for many people, their ED is their only point of contact with the healthcare system.<\/p>\n<p>\u201cIncreasing the rates of diagnosis and early diagnosis doesn\u2019t just have huge<b><i> <\/i><\/b>implications for individuals\u2019 health and public health, it would also be cost-effective.<\/p>\n<p>\u201cA recent economic assessment of the SEMES strategy<sup>4<\/sup> calculated that it would prevent 13,615 new infections and have potential savings for the healthcare system of \u20ac4,411 million in two decades, with an economic return of \u20ac224 per euro invested.\u201d <b><i>\u00a0<\/i><\/b><\/p>\n<p>Targeted screening is one of the two main methods of HIV screening in ED; the other is opt-out screening.<\/p>\n<p>A project in the England is using opt-out HIV testing in A&amp;Es in areas with the highest prevalence of HIV.\u00a0 All adults who are having blood tests while in A&amp;E are tested for HIV unless they opt out. In many areas, hepatitis B and hepatitis C are also tested for.<\/p>\n<p>Data from the 28 A&amp;Es participating in the first 100 days of the project (April to July 2022) shows that more than 250,000 HIV tests were carried out. There were 128 HIV diagnoses, 325 hepatitis B diagnoses and 153 hepatitis C diagnoses.<sup>5<\/sup><\/p>\n<p>\u201cIt would be difficult to implement a universal testing strategy like this in Spain, where explicit consent for HIV testing is required,\u201d says Dr Gonz\u00e1lez del Castillo.\u00a0 \u201cIn addition, some ED physicians may be reluctant to order tests that will not help them diagnose and treat the condition that patient has presented with.<\/p>\n<p>\u201c<span lang=\"EN-US\">Targeted HIV screening in the ED, as we are doing in Spain, can be impactful, more cost-effective, and better accepted by both patients and physicians than universal testing.<\/span><\/p>\n<p><span lang=\"EN-US\">\u201cOn the other hand, we are working on recommendations for hepatitis B<\/span> and C testing and many EDs have already started doing it at the same time as HIV, with 63 new hepatitis C diagnosis in 2021 and 2022.\u201d<\/p>\n<p>He concludes: \u201cThe role that ED can play in HIV 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