Background
To analyze the time trends of HIV testing in Barcelona (Spain) and investigate if emergency departments (EDs) have changed HIV screening patterns and if the implementation of an opt-in targeted strategy for HIV testing in these EDs impacted these trends.
Methods
Between 2017-2023 (7 years), monthly HIV tests performed in 4 hospitals covering a population of 1.6-million inhabitants in Barcelona were recorded. Tests were classified as ordered by ED, other hospital departments (HD) or community healthcare centers (CHCC). Monthly ED attendances were also compiled, along with new HIV diagnosed performed in ED. Temporal trends were assessed by linear models. Between 2021 and 2022, the 4 EDs implemented an opt-in strategy to test every patient with targeted conditions on top of other classical reasons for HIV testing. Post-implementation HIV screening and new diagnoses in EDs were compared with the pre-implementation period.
Results
769,134 HIV tests were performed in 7 years (2,296/month-center): 430,582 (56.0%) by HD, 324,469 (42.2%) by CHCC and 14,083 (1.8%) by EDs. HIV tests steadily increased by 29 per month (R2=0.13, p<0.001), with HD-, CHCC and ED-ordered tests increasing by 11 (R2=0.14, p<0.001), 17 (R2=0.09; p<0.001) and 1 (R2=0.50, p<0.001), respectively. The rhythm of increment in ED testing was higher than in HD (p<0.001) and CHCC (p=0.04). There were 4.3 million ED visits (12,849/month-ED) and 0.33% were screened for HIV, with a significant 0.05% monthly increase of tested patients over time (p<0.001). There were 302 new HIV diagnoses performed in EDs (0.9/month-ED), resulting in a 2.1% of positive tests among the 14,083 screened patients, which decreased by -0.36% per year; R2=0.06, p<0.001. The opt-in targeted strategy was associated with higher increases in monthly HIV testing in EDs (p<0.001) and percentage of HIV tests ordered coming from EDs (from 1.62% to 2.08%, p<0.001); however, the percentage of ED comers screened, HIV new diagnoses and HIV tests resulting in new diagnoses did not vary (p=0.68, p=0.48 and p=0.78, respectively).
Conclusions
HIV screening in Barcelona increased from 2017 to 2023, and EDs incremented HIV screening more than HDs and CHCCs. Implementation of an opt-in targeted strategy for HIV screening in EDs increased the number of tests and the role of EDs in HIV testing, but not the proportion of patients tested or new HIV diagnoses made in EDs, probably due to the progressive decline of undiagnosed HIV people during the studied period.