National Trends in HIV Testing During Emergency Department Visits, 2016–2022

Routine, opt-out HIV testing enables early diagnosis and improves individual and public health outcomes. Centers for Disease Control recommendations that support routine HIV screening in emergency departments (EDs) have been in place for nearly two decades, however testing rates during ED visits remain low. National analyses suggest that HIV screening declined during the COVID-19 pandemic and did not rebound in 2021. We sought to evaluate national trends in HIV testing during ED visits.

This retrospective study utilized data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) spanning 2016 to 2022. Adult patients aged 18 years and older presenting to ED with an HIV test ordered during their visit were identified. NHAMCS variables were analyzed to assess patient demographics including age, sex, race, and insurance status, as well as ED visit characteristics such as mode of arrival, geographic region, resource utilization, Emergency Severity Index (ESI) score at triage, and disposition (admission versus discharge).

Overall, we identified 773,338,601 emergency department visits nationwide among patients who did not have a preexisting diagnosis of HIV. From 2016 to 2022, 5,375,185 HIV tests were performed or 0.7% of visits had an HIV test performed. HIV testing during ED visits increased overall from 0.52% in 2016 to 0.90% in 2022, with a transient decline during the COVID-19 pandemic and a marked rebound in 2022. Linear trend analysis demonstrated a statistically significant increase in HIV testing during emergency department visits over time (slope = +0.049% per year; 95% CI, 0.004–0.093; p = 0.037).

Although HIV testing during ED visits increased over time, overall testing rates remained low, occurring in fewer than 1% of visits annually. Ongoing work is needed to identify strategies to increase HIV screening during ED visits. The observed disruption during the COVID-19 pandemic, followed by rebound testing in 2022, highlights both system vulnerability and recovery, underscoring the ED’s ongoing potential role in routine HIV screening, diagnosis, and referral to treatment.