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Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Screening test of HIV in Emergency Departments: How? When? Who?
Journal Information
Vol. 36. Issue 3.
Pages 203-204 (March 2018)
Vol. 36. Issue 3.
Pages 203-204 (March 2018)
Letter to the Editor
DOI: 10.1016/j.eimce.2017.10.011
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Screening test of HIV in Emergency Departments: How? When? Who?
Test de despistaje de VIH en los servicios de urgencias: ¿cómo?, ¿cuándo?, ¿quién?
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Luis Picazo, María Luisa Docavo, Lucía Salgado Pérez, Francisco Javier Martín-Sánchez
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fjjms@hotmail.com

Corresponding author.
Servicio de Urgencias, Hospital Clínico San Carlos de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
Related content
Enferm Infecc Microbiol Clin. 2017;35:434-710.1016/j.eimce.2017.06.002
Juliana Reyes-Urueña, Laura Fernàndez-López, Luis Force, Manel Daza, Cristina Agustí, Jordi Casabona
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Dear Editor,

We read with great interest the article published by Reyes-Urueña et al., which documents, in a cohort of 2140 patients treated in an Accident and Emergency Department (A&E) in Barcelona during the period 2011–2013, that the prevalence of HIV was 0.15%, and the acceptance rate of a rapid HIV test was 95%.1 During the same study period, Pizarro Portillo et al. carried out a similar investigation, although they differed in the sampling method (subjects aged from 15 to 75 with criteria of blood extraction for analysis in A&E at the discretion of the attending physician, rather than subjects aged from 15 to 64 at the discretion of research nurses in triage) and the screening test (fourth generation enzyme immunoassay test rather than an oral fluid test), which showed a prevalence of 0.6% and a rejection percentage of 1.2% in an A&E department in Madrid.

Although these studies differ in the prevalence of HIV, which may be related to sociodemographic aspects or to the type of sampling carried out, it is evident that the screening test for HIV could be a cost-effective measure in the adult population treated in the A&E departments in our area. This would be justified both by the prevalence in A&E—as it is above 0.1%—and by the high prevalence of late diagnosis in Spain.2–4 Nevertheless, we believe that there are many aspects still to be clarified in the environment of A&E.

First of all, the available data come from research studies that do not reflect real life, and there is therefore little information about the logistical capacity of personnel and the time necessary to carry out the test routinely on all patients seen in A&E, or to be able to give the information in an appropriate way in the event of a positive result.5

Secondly, despite the high rates of acceptance of the screening test in the studies discussed above,1,6 it is known that there are barriers between physicians and patients in relation to performing the test in A&E; one of the most important being the desire to focus on the actual reason for consultation.7 In these terms, the best strategy for offering the test is unclear; whether by the doctor responsible for patient care, nursing staff in triage or in a parallel process, or on the patient's own initiative after learning that they have free access to the test.8,9

Thirdly, it is known that the prevalence of HIV in Spain is 0.4%,5 but what we do not know is the prevalence in the areas covered by the different A&E departments or whether, within these areas, there are unknown populations at increased risk of HIV infection. Pizarro Portillo et al. documented that being male, coming from other countries, having a history of hepatitis or tattooing, and infection as a reason for consultation, were all factors associated with having a positive HIV test.6

Bearing in mind that one in every two new diagnoses in Spain is a late diagnosis, in order to improve outcomes, it seems logical to adapt the prevention programmes to groups at the highest risk, such as young people and immigrants, especially if they report high-risk practices.10 In view of the above, and knowing that at times the only contact this group has with the healthcare system is A&E, we believe it is necessary to create a series of standardised recommendations for carrying out the HIV screening test in A&E, in order to establish the how, when and who.

References
[1]
J. Reyes-Urueña, L. Fernández-López, L. Force, M. Daza, C. Agustí, J. Casabona.
Estudio del impacto a nivel de salud pública del cribado universal del virus de la inmunodeficiencia humana en un servicio de Urgencias.
Enferm Infecc Microbiol Clin, 35 (2017), pp. 434-437
[2]
G.D. Sanders, A.M. Bayoumi, V. Sundaram, S.P. Bilir, C.P. Neukermans, C.E. Rydzak, et al.
Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy.
N Engl J Med, 352 (2005), pp. 570-585
[3]
R.P. Walensky, M.C. Weinstein, A.D. Kimmel, G.R. Seage, E. Losina, P.E. Sax, et al.
Routine human immunodeficiency virus testing: an economic evaluation of current guidelines.
Am J Med, 118 (2005), pp. 292-330
[4]
Secretaría del Plan Nacional sobre el Sida. Centro Nacional de Epidemiología. Vigilancia epidemiológica del VIH y sida en España. Actualización 30 de junio de 2016. Sistema de información sobre nuevos diagnósticos de VIH. Registro nacional de casos de sida. noviembre, 2016. Available from: http://www.msssi.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/vigilancia/InformeVIHSida junio2014.pdf2 [accessed 28.10.17].
[5]
R. Polo, E. García-Carrasco.
Detección de la infección por el VIH en los servicios de urgencias españoles: ¿realidad o utopía?.
Emergencias, 28 (2016), pp. 293-294
[6]
A. Pizarro Portillo, C. del Arco Galán, I. de los Santos Gil, F. Rodríguez Salvanés, M. Negro Rua, A. del Rey Ubano.
Prevalencia y características de los pacientes con infección por virus de la inmunodeficiencia humana (VIH) diagnosticados de novo en un servicio de urgencias.
Emergencias, 28 (2016), pp. 313-319
[7]
N. De Rossi, N. Dattner, M. Cavassini, S. Peters, O. Hugli, K.E. Darling.
Patient and doctor perspectives on HIV screening in the emergency department: A prospective cross-sectional study.
PLOS ONE, 12 (2017), pp. e0180389
[8]
J. Brown, R. Shesser, G. Simon, M. Bahn, M. Czarnogorski, I. Kuo, et al.
Routine HIV screening in the emergency department using the new US Centers for Disease Control and Prevention Guidelines: results from a high-prevalence area.
J Acquir Immune Defic Syndr, 46 (2007), pp. 395-401
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E. Martínez-Segura, M. Lleixà-Fortuño, T. Salvadó-Usach, E. Solà-Miravete, M. Adell-Lleixà, M.R. Chanovas-Borrás, et al.
Perfil competencial en los profesionales de triaje de los servicios de urgencias hospitalarios.
Emergencias, 29 (2017), pp. 173-177
[10]
Ministerio de Sanidad, Servicios Sociales e Igualdad.
Guía de recomendaciones para el diagnóstico precoz del VIH en el ámbito sanitario.

Please cite this article as: Picazo L, Docavo ML, Salgado Pérez L, Martín-Sánchez FJ. Test de despistaje de VIH en los servicios de urgencias: ¿cómo?, ¿cuándo?, ¿quién? Enferm Infecc Microbiol Clin. 2018;36:203–204.

Copyright © 2017. Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
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