Page 214 - HIVMED_v21_i1.indb

Page 5 of 9 Original Research

= HIV status: Unknown = HIV status: Posi ve
Total ED volume
4255 = HIV status: Nega ve = HIV status: Indeterminate

Pa ents approached
by HCT staff
2074 (48.7%)

Pa ents enrolled
1880 (90.6%)

Known HIV + pa ents Known HIV - pa ents Unaware of HIV status
370 (19.7%) 95 (5.0%) 1415 (75.3%)

Pa ents linked to care Pa ents who accepted HCT Pa ents who declined HCT
351 (94.9%) 1274 (90.0%) 141 (10.0%)

Pa ent has not tested Pa ent does not want to
Viral suppression: Achieved Viral suppression: Unsure in the past year know status
23 (6.5%) 282 (80.3%) 451 (35.4%) 53 (37.6%)
Pa ent has never Pa ent is in pain
been tested
242 (18.9%) 48 (34.0%)
Pa ent does not believe
Test is rapid and free they are at risk
237 (18.6%)
28 (19.9%)

Result: HIV posi ve Result: HIV nega ve Result: Indeterminate
159 (12.5%) 1102 (86.5%) 13 (1.0%)

HCT, HIV counselling and testing; ED, emergency department.
FIGURE 1: Flow diagram demonstrating study enrolment and outcomes.

Discussion The two most common reasons for accepting HCT in the ED
were ‘has not tested in the past year’, followed by ‘has never
We found acceptance of HCT services in the ED to be been tested’. This positively implies the need for HCT in
reassuringly high. Our study revealed that 90% of patients acute care settings, to cover the existing testing gap, as we are
who were unaware of their HIV status accepted HIV testing. able to capture patients who are currently missed by other
This was observed despite patients being in a clinical testing venues within the healthcare system. Recently, novel
environment where HIV testing is not routinely offered and
where patients present with acute injury or illness and are approaches for HCT – such as home-based, community-
based and couples testing – have been added to traditional
often in pain or moderate distress. 11,18 These findings are
consistent with results from other LMICs. In Kenya and facility-based HCT delivery systems, with good acceptance
21,22
Guyana, it was found that 97.7% and 75.5% of non-critical rates. A systematic review of HCT strategies in sub-
patients accepted HCT in the ED, respectively. 19,20 Our results Saharan Africa reported an acceptance rate of 70% for home-
21
also highlight a substantial burden of undiagnosed HIV: based testing and 76% for community-based testing.
8.5% of enrolled patients were newly diagnosed as HIV However, despite the variety of testing strategies and venues,
positive. These patients presented to the ED for various a testing gap remains, particularly amongst young adults
clinical complaints, and a positive diagnosis of HIV was an and men. 23,24 Considering that 44.1% of all patients accepting
incidental finding. testing were young adults (18–30 years) and 52.7% were

http://www.sajhivmed.org.za 206 Open Access