How to Better Screen for Blood-Borne Viruses, Specifically HIV, in Hospital Emergency Departments: French and European Perspectives.

Hospital emergency departments (EDs) represent an acceptable and economically viable source of data on screening for blood-borne viruses (BBVs). In EDs in France, BBV screening is not based on a universal 'opt-out' policy (i.e. where all patients are informed that they will be screened unless they decline). Screening for BBVs is often not systematically offered when clinically appropriate and may have several challenges when it is offered. Nonetheless, opt-out BBV screening is useful in varied urban populations where BBV prevalence is high, although further evaluations of patient, caregiver and provider acceptability, rates of repeat versus new diagnoses, linkage to care (LTC) and cost benefits are warranted. Timely LTC and the retention of patients within care are important for enhancing clinical outcomes and preventing BBV transmission. However, timely LTC may be adversely affected by social deprivation, stigma associated with a BBV diagnosis and poor healthcare organisation. Consistent political commitment and relevant resource allocation are required to target any inequalities in healthcare access. Overall, in France and Europe, universal ED opt-out BBV screening strategies are appropriate for reducing missed opportunities for the early diagnosis of BBV infections. These strategies should be more widely implemented in EDs with high BBV prevalence, together with targeted community-based BBV screening in high-risk and vulnerable populations, so that overall BBV screening remains cost-effective. Reducing BBV-related stigma and discrimination and other barriers to healthcare access is imperative, as is the ongoing need to reinforce and evaluate timely LTC after positive opt-out BBV screening in EDs.