More than 25 percent of people with HIV have no idea that they are infected, yet this population is responsible for more than 55 percent of all new infection.
African-Americans still lead the pack in estimated number of diagnoses of HIV infection and Black women are the fastest growing population contracting HIV. These statistics are taken from the Centers for Disease Control and Prevention (CDC).
Many people are surprised at how such a small segment of the population can have such a large impact with HIV.
Because of these numbers, the Wishard Emergency Department at Wishard Health Services decided to provide universal HIV screenings to test adult patients in an effort to prevent the spread of the disease.
“Many people don’t have primary care. The only care they have is the emergency department. Those that are insured also are coming to the ER because there is a culture that this department is convenient. So we are busy from both uninsured and insured and we must do our best to help as many people as we can,” said Lee Wilbur, associate professor of clinical emergency medicine at Indiana University School of Medicine. Only a few hundred ambulatory care centers in the country are able to pull off such a feat and Wishard is one of them, even with their limited resources. This is due to careful planning and their comprehensive informatics system. Wishard is one of the busiest emergency departments in the state of Indiana.
Universal HIV screenings in ERs are also significant to reducing the spread of the disease because previously, HIV advocates primarily targeted certain types of people – risk-based HIV testing such as drug users and those with multiple sexual partners. With Wishard’s newest method, they are able to test a more diverse population and are able to compile better statistics.
Universal testing in no way means that every single person that steps foot into Wishard’s ER is tested. If you are between the ages of 13 and 64 years old and not known to be HIV positive, you are considered eligible for universal testing based on the CDC criteria. The test is voluntary and is an effort to capture every possible newly-infected individual and those that are unaware of their disease.
Wishard’s sophisticated computer system determines eligibility by instantly accessing the patient’s medical records. Those who have HIV or have been tested at Wishard in the past year and have been negative will not be tested.
“We are identifying patients much earlier in their disease than if we did targeted screening so we can get them into care and contribute to greater chances of survival,” said Wilbur. He went on to say that due to advancements in HIV there is some complacency when it comes to early screenings.
Patients are screened using the oral antibody test and get their results before they leave the ER. Those who are positive are immediately given counseling and medical resources such as an appointment with the Infections Disease Clinic. Recognized HIV-positive individuals out of care will be given resources as well.
Thus far, Wishard has an excellent consent rate when it comes to their new (and free) universal HIV screening program. Fear is a major reason why many decline the test.
Currently, there are two nurses who administer the universal testing for 12 hours a day, however, this program is expected to expand soon and has dedicated space in the new Wishard facility scheduled to open at the end of 2013.
They are also planning to expand Wishard’s nine community health centers.