Implementation and Outcomes of Routine HIV Screening in the Emergency Department of an Urban, Tertiary Care Hospital

Screening for human immunodeficiency virus (HIV) infection is a critical component to ending the epidemic by identifying asymptomatic patients and connecting them to care. Emergency departments (EDs) are uniquely positioned to reach high-risk, underserved populations.

An HIV screening program was implemented in an urban, academic ED that serves a diverse population, including immigrants and persons who inject drugs. Screening followed CDC recommendations. Patients ≥ 18 years with phlebotomy ordered underwent automated retrospective assessment for prior HIV testing. If never tested, HIV testing was automatically ordered, with increased frequency of order for those with intravenous drug use (IVDU) or recent sexually transmitted infections. Patients unable to consent to testing were excluded.

From 04/01/2025 to 09/30/2025, 6551 patients were tested, a 509% increase over the prior 6 months. Among screened individuals, mean age was 51.8 ± 19.6 years, 36.6% were African American, and 49.7% were female. Forty-four patients had reactive results; 12 (27%) were determined to be false positives. Of thirty-two true positives, 14 (44%) were previously undiagnosed cases. Risk factors among newly diagnosed patients included men who have sex with men (n=3), IVDU (n=3), transgender female (n = 1), and recent immigration (n=7). Mean CD4 count at diagnosis was 257 ± 238 cells/mm3, with half < 200. Eight (57%) newly diagnosed patients were admitted, most for HIV-related complications. Of newly diagnosed individuals, 100% were connected to care or confirmed planned connection to care.

Routine, guideline-based ED HIV screening is feasible and substantially increases testing volume and new diagnoses in high-risk populations.