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Efficiency of screening for human immunodeficiency virus infection in emergency departments: a systematic review and meta-analysis

González Del Castillo J, Fuentes Ferrer ME, Fernández Pérez C, Molina Romera G, Núñez Orantos MJ, Estrada Pérez V

Health Research Institute, Hospital San Carlos (IdISSC), Madrid, Spain. Emergency Department, Hospital Clínico San Carlos, Madrid, Spain. Preventive Medicine Service, Unidad de Apoyo Metodológico a la Investigación (UAMI), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. Service of Preventive Medicine, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain. Internal Medicine-Infectious Diseases Service, Hospital Clínico San Carlos, Madrid, Spain.

Background and objective. The rates of undiagnosed and late-diagnosed human immunodeficiency virus (HIV) infection are high. Screening for HIV infection in hospital emergency departments (EDs) could offer a way to increase the number of diagnoses. Our aim was to analyze whether universal hospital ED screening for HIV is efficient.
Methods. We followed the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, the Cochrane Library, LILACS, Scopus, EMBASE, and the Web of Science were searched using the following terms: “HIV infections/epidemiology,” “AIDS serodiagnosis,” “emergency service, hospital,” “prevalence,” and “mass screening/methods.” The searches were limited to a 5-year time frame (2016–2020); only publications in English or Spanish were collected. We included studies of universal HIV screening among hospital ED patients and evaluated them using the Quality Assessment Tool for Quantitative Studies.
Results. A total of 273 articles were identified. Twelve met the inclusion criteria. The studies analyzed 103 731 patient samples and yielded 652 new HIV diagnoses. A random effects model estimated an overall new-diagnosis prevalence of 0.60% (95% CI, 0.39%–0.84%). The heterogeneity statistic I2 was high, at 90.02% (P < .001). Estimates of prevalence based on studies carried out in Europe, the United States, and Africa were, respectively, 0.48% (95% CI, 0.13%–1.03%), 0.54% (95% CI, 0.33%–0.40%), and 5.6% (95% CI, 3.37%–9.2%). The studies received quality ratings of moderate or strong.
Conclusion. Although the reviewed studies applied various screening strategies to identify new HIV diagnoses, our findings support the conclusion that universal screening is efficient.

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