International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2025
Indicator condition-based and risk-factor guided HIV testing in the emergency department: An effective strategy to increase new diagnoses in Italy.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Lazzaro Alessandro, Tincati Camilla, Romano Francesco, Santoro Andrea, Bortolani Luca, Santinelli Letizia, Ceccarelli Giancarlo, Galardo Gioacchino, Biamonte Federica, Marchetti Giulia, d'Ettorre Gabriella
Аннотация
OBJECTIVES: This study evaluated the feasibility and effectiveness of clinical indicator conditions (ICs)-guided and epidemiological risk factors (RF)-based provider-initiated HIV testing in Italian urban Emergency departments (EDs) within the current opt-in legal framework.
METHODS: A multicenter cross-sectional study was conducted from September 2022 to September 2023 in the EDs of two urban hospitals in Rome and Milan. Adults with one or more pre-defined ICs and/or RFs were offered HIV testing. Demographic, clinical and historical data were collected, and multivariable logistic regression was used to identify predictors of HIV test reactivity.
RESULTS: Among 826 enrolled participants, 12 new HIV diagnoses were made, yielding a reactivity rate of 1.45% (95% CI 0.82-2.54). ICs associated with test reactivity included mononucleosis-like illness, seborrheic dermatitis/exanthema, and pneumonia. Key RFs associated with positivity included being a migrant from a high-HIV-endemic country, MSM status, and injection drug use. Most newly diagnosed individuals had CD4+ T lymphocytes counts <350 cells/µL, and missed opportunities for earlier testing were identified in 66.7% of evaluable cases.
CONCLUSION: Provider-initiated HIV testing in EDs guided by ICs and RFs is feasible and effective within the Italian opt-in framework, enhancing early HIV case detection, supporting broader implementation as part of national testing strategies.
METHODS: A multicenter cross-sectional study was conducted from September 2022 to September 2023 in the EDs of two urban hospitals in Rome and Milan. Adults with one or more pre-defined ICs and/or RFs were offered HIV testing. Demographic, clinical and historical data were collected, and multivariable logistic regression was used to identify predictors of HIV test reactivity.
RESULTS: Among 826 enrolled participants, 12 new HIV diagnoses were made, yielding a reactivity rate of 1.45% (95% CI 0.82-2.54). ICs associated with test reactivity included mononucleosis-like illness, seborrheic dermatitis/exanthema, and pneumonia. Key RFs associated with positivity included being a migrant from a high-HIV-endemic country, MSM status, and injection drug use. Most newly diagnosed individuals had CD4+ T lymphocytes counts <350 cells/µL, and missed opportunities for earlier testing were identified in 66.7% of evaluable cases.
CONCLUSION: Provider-initiated HIV testing in EDs guided by ICs and RFs is feasible and effective within the Italian opt-in framework, enhancing early HIV case detection, supporting broader implementation as part of national testing strategies.