Seroprevalence study using oral rapid HIV testing in a large urban emergency department

J Emerg Med. 2012 Nov;43(5):e269-75. doi: 10.1016/j.jemermed.2012.02.021. Epub 2012 Apr 26.


Background: The Centers for Disease Control (CDC) recommends universal human immunodeficiency virus (HIV) testing for patients aged 13-64 years in health care settings where the seroprevalence is>0.1%. Rapid HIV testing has several advantages; however, recent studies have raised concerns about false positives in populations with low seroprevalence.

Study objectives: To determine the seroprevalence of HIV in our Emergency Department (ED) population, understand patient preferences toward rapid testing in the ED, and evaluate the performance of a rapid oral HIV test.

Methods: A serosurvey offered oral rapid HIV 1/2 testing (OraQuick ADVANCE, Bethlehem, PA) to a convenience sample of 1348 ED patients beginning August 2008. Subjects declining participation were asked to complete an opt-out survey.

Results: 1000 patients were tested. Twelve had positive results (1.2%), including one who had newly diagnosed HIV infection; 988 patients tested negative. Of these, 335 (33.3%) had never been tested; 640 had prior history of a negative HIV test. No false-positive rapid HIV results were detected; 98.7% received the results of their preliminary HIV test, including 100% of those who tested positive. Most subjects who declined testing cited either a recent negative HIV test (160/348) or low perceived risk (65/348). A minority cited a concern regarding their privacy (11/348) or that the test might delay their treatment (7/348).

Conclusions: The seroprevalence estimate of 1.2% was above the rate recommended by the CDC for routine universal opt-out testing in our study population. The acceptance rate of rapid HIV testing and the percentage of patients receiving results approximated other recent reports.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS Serodiagnosis / methods*
  • Adolescent
  • Adult
  • Chicago / epidemiology
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • HIV Antibodies / analysis
  • HIV Antibodies / blood
  • HIV Infections / diagnosis
  • HIV Infections / epidemiology*
  • HIV Seroprevalence
  • Hospitals, Urban
  • Humans
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Patient Acceptance of Health Care
  • Saliva / immunology
  • Young Adult


  • HIV Antibodies