Only about 10% of people referred for HIV testing by emergency room personnel ever go to clinics to obtain the testing, according to a study published in the January issue of the Journal of Acquired Immune Deficiency Syndromes, Reuters Health reports. Emergency room doctors are in a "unique position" to target undiagnosed HIV infection, because undiagnosed HIV infection is common among low-income patients, "the same patients who commonly seek care in public hospital [emergency rooms]," Dr. Roger Lewis of Harbor-UCLA Medical Center said (Reuters Health, 1/21). Lewis and colleagues collected data from 586 referrals made by an urban emergency department for outpatient HIV testing. Of the 586 referrals, 494 patients met the inclusion criteria for the study. Only 56 of the 494 patients went to the clinic and completed pretest counseling. Of these, 51 tested HIV-negative, four tested HIV-positive and one refused to be tested. The researchers concluded that the referral system was ineffective at identifying unrecognized HIV infection (Coil et al., Journal of Acquired Immune Deficiency Syndromes, 1/1). The researchers suggested that rapid HIV testing, which could be conducted at the hospital, may increase detection of previously undiagnosed HIV infection. In addition, the researchers are conducting a follow-up study to determine whether financial incentives improve compliance with outpatient HIV testing referrals. Lewis said that new approaches to the problem are important because "a large proportion of at-risk patients delay testing or fail to get tested, even when they are referred for HIV testing, and thus miss an opportunity to learn their status, protect others and to potentially benefit from [antiretroviral drugs]" (Reuters Health, 1/21).

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