Trial reportJournal of acquired immune deficiency syndromes (1999)2013
Randomized comparison of universal and targeted HIV screening in the emergency department.
Trial report in Journal of acquired immune deficiency syndromes (1999), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
45 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Risk-Based Screening Tools to Optimise HIV Testing Services: a Systematic Review.Current HIV/AIDS reports · 2022Pooled it
- Cost-Effectiveness of HIV Screening in Emergency Departments: Results From the Pragmatic Randomized HIV Testing Using Enhanced Screening Techniques in Emergency Departments Trial.Annals of emergency medicine · 2024Trial
- Comparison of HIV Screening Strategies in the Emergency Department: A Randomized Clinical Trial.JAMA network open · 2021Trial
- Trial
- The impact of nurse-driven targeted HIV screening in 8 emergency departments: study protocol for the DICI-VIH cluster-randomized two-period crossover trial.BMC infectious diseases · 2016Trial
- Patient choice in opt-in, active choice, and opt-out HIV screening: randomized clinical trial.BMJ (Clinical research ed.) · 2016Trial
- Innovation and implementation determinants of HIV testing and linkage-to-care in the U.S.: a systematic review.Implementation science communications · 2024Review
- A Cross-Sectional Review of HIV Screening in High-Acuity Emergency Department Patients: A Missed Opportunity.The western journal of emergency medicine · 2024Article
- An Opt-Out Emergency Department Screening Intervention Leads to Major Increases in Diagnosis of Syphilis.Open forum infectious diseases · 2024Article
- Article
- Reassessing HIV Detection Strategies: An Analysis of Opportunistic Screening vs. Indicator-Condition-Driven Diagnosis in Valencia, Spain.Journal of community health · 2024Article
- An automated best practice advisory increases both routine HIV screening and HIV cotesting with sexually transmitted infections in the emergency department.American journal of infection control · 2024Article
- Testing Cancer Patients for HIV: Just Do It.Acta medica Philippina · 2024Article
- Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments.HIV medicine · 2022Observational
- Comparison of Targeted and Routine Adolescent HIV Screening in a Pediatric Emergency Department.Pediatric emergency care · 2022Article
- Reimagining Preexposure Prophylaxis Provision for Women in the United States.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Article
- Opt-out universal HCV and HIV screening in a Canadian emergency room: a cross-sectional study.BMJ open · 2022Article
- COVID-19 and beyond: Lessons learned from emergency department HIV screening for population-based screening in healthcare settings.Journal of the American College of Emergency Physicians open · 2021Article
- Missed Opportunities for Human Immunodeficiency Virus (HIV) Testing During Injection Drug Use-Related Healthcare Encounters Among a Cohort of Persons Who Inject Drugs With HIV Diagnosed During an Outbreak-Cincinnati/Northern Kentucky, 2017-2018.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- How to best conduct universal HIV screening in emergency departments is far from settled.Journal of the American College of Emergency Physicians open · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
objectiveUniversal HIV screening is recommended but challenging to implement. Selectively targeting those at risk is thought to miss cases, but previous studies are limited by narrow risk criteria, incomplete implementation, and absence of direct comparisons. We hypothesized that targeted HIV screening, when fully implemented and using maximally broad risk criteria, could detect nearly as many cases as universal screening with many fewer tests.
methodsThis single-center cluster-randomized trial compared universal and targeted patient selection for HIV screening in a lower prevalence urban emergency department. Patients were excluded for age (<18 and >64 years), known HIV infection, or previous approach for HIV testing that day. Targeted screening was offered for any risk indicator identified from charts, staff referral, or self-disclosure. Universal screening was offered regardless of risk. Baseline seroprevalence was estimated from consecutive deidentified blood samples.
resultsThere were 9572 eligible visits during which the patient was approached. For universal screening, 40.8% (1915/4692) consented with 6 being newly diagnosed [0.31%, 95% confidence interval (CI): 0.13% to 0.65%]. For targeted screening, 37% (1813/4880) had no testing indication. Of the 3067 remaining, 47.4% (1454) consented with 3 being newly diagnosed (0.22%, 95% CI: 0.06% to 0.55%). Estimated seroprevalence was 0.36% (95% CI: 0.16% to 0.70%). Targeted screening had a higher proportion consenting (47.4% vs. 40.8%, P < 0.002), but a lower proportion of ED encounters with testing (29.7% vs. 40.7%, P < 0.002).
conclusionsTargeted screening, even when fully implemented with maximally permissive selection, offered no important increase in positivity rate or decrease in tests performed. Universal screening diagnosed more cases, because more were tested, despite a modestly lower consent rate.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.