An HIV-testing program at University
Hospital's emergency department could provide a national model for
effective screening of 110 million emergency department patients a
year, and put a serious dent in the spreads of AIDS.
Although emergency departments often see
patients with HIV risk factors, they lack the resources to provide HIV
testing. That's where University Hospital's HIV Early Intervention
Program can make a difference.
A collaboration involving the UC Academic
Health Center and Cincinnati Health Network, and funded by Ohio
Department of Health, the program identified 45 HIV-positive patients
at the hospital from Jan. 1, 1999, through Dec. 31, 2002. All were
counseled and referred for treatment and disease-prevention education.
"Emergency departments can play an
important role in stopping the spread of infectious diseases if they
have health department resources to work with," explains Michael Lyons,
MD, assistant professor of emergency medicine at the College of
Medicine. "Ohio Department of Health's support has enabled us to
develop a program that wouldn't be possible elsewhere.
"Applying this health department/ER
partnership model to the 110 million ER visits in the United States
each year could lead to rapid changes in public health in our country
in terms of HIV detection," he says. "It could also provide a model for
addressing other public health issues such as immunization and patient
Dr. Lyons is the lead author of an
article published in the May-June issue of the journal Public Health
Reports that details how public health programs in academic/hospital
emergency departments can effectively detect and help prevent the
spread of infectious diseases.
Dr. Lyons and his team studied counseling
and testing data at the five sites funded by Ohio Department of Health
in Hamilton County. They found that 5,232 of the 26,382 patients tested
were seen at University Hospital's emergency department.
The study showed that although University
Hospital's emergency department program accounted for 19.8 percent of
all tests, it identified 24.7 percent of all HIV-positive patients.
Despite the fact that emergency services
are often considered a high-cost option for medical care, Dr. Lyons
points out, the actual cost per positive HIV test in the emergency
department was 9 percent cheaper than at community health centers.
The study also revealed that hospital
emergency department patients were more likely to consent to HIV
testing than those using community clinics.
Co-author Christopher Lindsell, PhD, of
UC's Institute for the Study of Health, explains: "It's much simpler to
say yes to a test when you're already in the ER, than to go to a clinic
and request the test yourself."
Testing in the emergency department has another significant advantage, Dr. Lindsell points out.
"Emergency room patients have often taken
a risk that has caused illness or injury," he explains. "However,
studies show that people with one risky behavior may take risks in
other areas of their life, such as sexual or other lifestyle choices,
that can increase the risk of HIV infection."
Patients who test positive during
emergency department screening receive free counseling at University
Hospital and are referred to UC's Infectious Disease Center, where they
learn how they can help control the virus and slow the progression to