Rapid Hiv Testing in emergency departments A cme

Rapid HIV Testing
in Emergency Departments
A CME-Accredited Resource
S P R I N G
Albany
Medical
College
division of
HIV medicine
2 0 0 8
Dear Colleague,
LEAD AUTHOR
The Centers for Disease Control (CDC) has recently made new recommendations for the testing of individuals
for HIV. This is in response to the fact that although major strides have been made in the treatment of HIV and
survival, new infections continue to occur at the rate of approximately 40,000 new infections per year. This new
infection rate is primarily driven by the 25% of HIV-infected individuals who do not yet know they are infected.
It is clear that previous testing strategies have failed, and new strategies are needed.
The CDC hopes and believes that wider testing in the acute primary care setting will greatly increase
HIV status awareness, and reduce the number of persons who are unaware of their infection.
We hope that this monograph will prepare you to begin testing in your Emergency Department.
Ralph Liporace, MD, AAHIVS
Medical Director
Clinical Research Program
Division of HIV Medicine
Albany Medical College
Albany, NY
CO-AUTHORS
Thank you,
Wayne R. Triner, DO
Ralph Liporace, MD AAHIVS
TA R G E T A U D I E N CE
This monograph is designed for physicians,
physician assistants, nurse practitioners,
registered nurses and licensed practical
nurses in an emergency department setting.
FACULTY DISCLOSURE
Ralph L. Liporace, MD, AAHIVS
speaker’s bureau:
Gilead Sciences, Inc., Pfizer, Inc., Roche
Laboratories, Inc. & Tibotec Therapeutics
L E A R N I N G O B J E CTIVES
By the end of this module, the reader
should be able to:
Douglas G. Fish, MD
1) Describe the current epidemiology of HIV infection in the United States.
2) Discuss HIV Acute Retroviral Syndrome.
3) Identify patients at high risk for HIV
infection in the Emergency Department.
4) Review the current CDC guidelines for testing patients for HIV, tailored to State Law.
5) Outline how to initiate HIV testing in Emergency Departments using rapid HIV tests.
Gilead Sciences, Inc. &
Roche Laboratories Inc.
A C C R E D I TAT I O N
Albany Medical College is accredited by
the Accreditation Council for Continuing
Medical Education (ACCME) to provide
continuing medical education for physicians.
The Albany Medical College designates
this educational activity for a maximum
of 1 AMA PRA Category 1 CreditTM. Physicians should only claim credit
commensurate with the extent of their
participation in the activity.
A C K N O W L E D G E MENTS
This monograph is a collaborative
initiative among the Division of HIV
Medicine at Albany Medical College,
in partnership with the New York/
New Jersey AIDS Education &
Training Center.
Thank you to Gilead Sciences, Inc.
for their support via an unrestricted
educational grant.
Sp e a k e r ’ s B u r e a u :
C o n s u lt a n t :
Monogram Biosciences, Tibotec
Therapeutics & Trimeris
Wayne R. Triner, DO, W. Patrick Bowden,
PA, AAHIVS, Abigail V. Gallucci,
Sarah J. Walker, Jennifer L. Price
& Cathryn R. Corlew:
These individuals have no financial
arrangement or affiliation with any
corporate organizations that offer
financial support for continuing medical
education activities.
Attending Physician
Emergency Medicine
Albany Medical College
Albany, NY
W. Patrick Bowden, PA, AAHIVS
Nicholas A. Rango HIV Clinical Scholar
Division of HIV Medicine
Albany Medical College
Albany, NY
EDITORIAL BOAR D
Lead Editor & Course
Director
Douglas G. Fish, MD
Medical Director
AIDS Designated Center
Assistant Professor of Medicine
Albany Medical College
Albany, NY
Project Managers
Abigail V. Gallucci
Director of AIDS Education
Division of HIV Medicine
Albany Medical College
Albany, NY
Sarah J. Walker, MS
Associate Director of Correctional Education
Division of HIV Medicine
Albany Medical College
Albany, NY
C o n t i n u i n g E d u c at i o n
Director
Jennifer L. Price
Office of Continuing Medical Education
Albany Medical College
Albany, NY
P r o d u c t i o n A s s i s ta n t
Cathryn R. Corlew
Education & Outreach Coordinator
Division of HIV Medicine
Albany Medical College
Albany, NY
Rapid HIV Testing
in Emergency
Departments
A CME-Accredited
Resource
About Continuing Medical
Education (CME)
To obtain CME credit, a minimum of 70% of the questions
must be answered correctly on the self assessment test on page 9.
The estimated time for completion of this activity is 1 hour.
There is no fee for the CME credit for this monograph.
This learning activity is awarded 1.0 contact hour until
June 30, 2008.
Directions
1. Time yourself throughout all portions of this activity.
2. Read the enclosed monograph.
3. Take the self assessment test.
4. Fill out the program evaluation. Please be sure to include
the length of time it took you to complete the activity,
self assessment test, and evaluation.
5. Complete the reader information form including your
name and address.
6. Fully complete the HRSA participant information form in
black pen. Each bubble must be fully shaded.
7. To assure your receipt of CME credit, please mail your
completed self assessment test, program evaluation, reader
information form and HRSA participant information
form (3 pages total) to:
Cathryn R. Corlew
Albany Medical College
47 New Scotland Avenue, Mail Code 158
Albany, NY 12208
If you have any questions, please contact Cathryn R. Corlew
at (518) 262-6864 or corlewc@mail.amc.edu.
PAGE 1
Rapid HIV Testing in Emergency Departments
A CE ME
d i t-i A
o cnc r1e d i t e d R e s o u r c e
INTRODUCTION
WHY TEST IN THE EMERGENCY DEPARTMENT?
More than twenty five years into the HIV epidemic,
the spread of HIV continues unabated, with
approximately 40,000 new infections annually in
the United States. Currently, there are approximately
1,000,000 persons in the United States living with
HIV; approximately 25% or 250,000 persons are
unaware of their infection.1 Some estimate that as
many as 75% of new cases are transmitted from
the 25% of HIV-infected individuals who are
unaware of their status.2 According to the Kaiser
Family Foundation, which conducted a survey via
telephone interviews with 2,517 respondents, 46%
of respondents had never been tested for HIV and
of those, 61% stated the reason for not being tested
was that they did not feel they were at risk.3 Lack of
risk perception has led to a lack of status awareness.
Since a tremendous increase in HIV infection rates is
occurring in persons who do not have traditional risk
factors, risk-based testing is proving ineffective
in containing the spread of HIV.
Often individuals who are ultimately diagnosed
with HIV have been seen in acute care settings years
before receiving an HIV diagnosis and are not tested
for HIV. Of 4,315 cases of HIV infection in South
Carolina during 2001-2005, 41% were in persons
in whom AIDS was diagnosed within 1 year of their
initial HIV diagnosis, demonstrating how late in
their infection they were actually diagnosed.5 73% of
these late testers had visited a health care facility at
least once prior to their first positive HIV test. 79%
of these visits did not involve diagnoses that would
have prompted HIV testing, providing evidence
and highlighting the need for routine screening
rather than screening based on risk. Of these cases
of HIV late testers, 79% had visited an Emergency
Department (ED), 12% had been inpatient, 7%
had made outpatient visits, and 1% had been seen
in a free clinic prior to being diagnosed with HIV
infection.5 This again demonstrates the necessity of
routine testing, not risk-based testing, and the utility
of testing in the ED.
TESTING GUIDELINES
Recently there have been major revisions to the
HIV Testing of Adults, Adolescents, and Pregnant
Women in Health-Care Settings Recommendations
published by the Centers for Disease Control (CDC).4
Recognizing the limitations of HIV testing based
solely upon traditional risk factors, the CDC has
proposed routine voluntary testing for patients ages
13-64 in all healthcare settings – not based upon
risk. Additionally, the recommendations suggest that
medical providers offer opt-out testing. In opt-out
testing, a separate informed consent for HIV testing is
not necessarily required, and prevention counseling/
pre-test counseling is not required. Check with your
health department regarding the law in your state.
Status awareness also has the potential to prevent
transmission and reduce high-risk sexual behavior.
Mother-to-child transmission (MTCT) has been
reduced to < 2%, with universal screening of
pregnant women in combination with prophylactic
administration of antiretroviral drugs, scheduled
cesarean delivery when indicated, and avoidance of
breastfeeding. In a meta-analysis of 8 studies, the
prevalence of unprotected vaginal or anal intercourse
with uninfected partners was, on average, 68% lower
for HIV-infected persons who were aware of their
status, compared to HIV-infected persons unaware
of their status. This highlights that status awareness
does often influence personal behavior.2
PAGE 2
As demonstrated by the South Carolina study, many
visits are made to the ED and patients at risk for HIV
are not being screened. Given that rates of new HIV
infections may have risen in some groups and that
Rapid HIV Testing in Emergency Departments
traditional risk-based testing is not working, many
states such as New York are embarking on a program
to make HIV testing more widely available in acute
care settings, including the ED.
BARRIERS TO HIV TESTING IN THE ED
Current barriers to HIV testing in EDs arise from two
principle areas: the lack of resources required for testing
and perception of the role of the ED in the healthcare
system. Although the CDC no longer recommends
pre- and post-test counseling, it is legally required as
part of the public health laws in many states.
Public health law that addressed HIV testing
originated at a time when there was no effective
treatment, and significant social stigma was attached
to the diagnosis. These regulations were aimed at
protecting the individual’s privacy and sensitivity
to the psychological impact associated with a nontreatable fatal illness. At that time, such protections
were required to facilitate a willingness to undergo
HIV testing. As a result, HIV testing is not handled
in the same manner as most other diagnostic
testing carried out in the ED. There are significant
requirements for pre- and post-test counseling as
well as availability of appropriate follow-up medical
care. In the present context, providers engaged in
traditional ED clinical activities would find it difficult
to fulfill the requirements mandated for HIV testing.
Therefore, centers that have initiated routine testing
of ED patients for HIV have utilized personnel whose
sole job is to carry out HIV testing and the associated
requirements. As a result, the cost of such programs
must be included in planning. To date, most of these
programs have been linked to external funding.
The second barrier to routine ED testing for HIV is
the diversion of ED activity from an acute care to a
public health role. Though EDs have long played an
indirect or implicit role in public health activities,
until now disease screening of asymptomatic patients
has not been mandated by public health agencies. It
is, however, the unique nature of many patients seen
in EDs that makes this initiative attractive; namely
that for many individuals, their healthcare encounters
occur only in EDs.
Rapid HIV Testing in Emergency Departments
There is some experience with routine ED testing
for HIV reported in peer-reviewed literature.6,7,8,9
Almost all centers that have undertaken this have
done so as either a pilot program or as part of an
academic endeavor with external funding. The rate
of willingness to be tested has been in the range of
40% to 70% and may be partially related to perceived
risk and community factors. Most programs report a
positive finding in one to two percent of those tested,
and this may be linked to the community prevalence
of HIV.6,7,8,9
Administratively, there are important elements of ED
HIV testing to consider. There are occasions when
an individual’s test result, either positive or negative,
is not available upon conclusion of the ED visit (as
may happen when a patient leaves the ED prior to
completion of care, or from administrative failures
whereby results are not reported to the patient). In
such cases, our obligation is to expend significant
efforts to locate the individual and make the results
known to him/her. The linking of an individual
to confirmatory testing and follow-up care may be
challenging. Financial incentives and immediate
referral (walking the patient to the appropriate clinic
at the time of ED discharge) have been shown to
increase this connection to care.8
The culmination of these factors may increase the
cost of such a program for each case diagnosed and
linked to follow-up care.10 Combined, these factors
sharply illustrate the need for administrative expertise
in overseeing these programs. Additionally, ED HIV
testing will require aggressive quality assurance and
ongoing cost analysis.
There is the possibility of improving the lives of many
by reducing transmission of HIV and by linkage to
care through ED testing.10 Yet the initiative comes at
a time when EDs are stressed with increasing numbers
and complexity of patients, and with challenges
for reimbursement and unmet workforce needs.
Initiating such a program will require ingenuity and
motivation to ensure success. Regulatory agencies
may need to participate by restructuring the legal
mandates that accompany HIV testing in your state,
creating financial avenues to support the initiative and
PAGE 3
providing data for use in quality assurance for
your state.
ACUTE HIV IN THE EMERGENCY DEPARTMENT
In 1985 the first description of acute HIV infection
was described as a “mononucleosis-like” illness.13
Since that time, multiple larger studies have described
the clinical and laboratory features of primary or
acute HIV infection. This identification of acute
HIV infection is made more urgent for several
reasons. First there is an emerging body of research
which suggests that starting antiretroviral therapy
during acute HIV infection may improve prognosis
by preserving the HIV-specific immune response.11
Second, as stated earlier, the majority of new HIV
infections are coming from that population of
individuals who are unaware of their infection.
Early identification and intervention can help to
significantly reverse this trend.
A variety of symptoms and signs may be seen in
association with acute HIV infection. The most
common findings are fever, lymphandenopathy, sore
TABLE 1:
SYMPTOMS
throat, mucocutaneous lesions, myalgia/arthralgia,
diarrhea, headache, nausea/vomiting, and weight
loss (Table 1).12 Generally, any instance where
mononucleosis enters the differential diagnosis, so
should acute HIV infection.
It is difficult to determine the incidence of
symptomatic versus subclinical primary HIV
infection. However, the majority of patients with
primary HIV infection appear to be symptomatic.
Several studies place the incidence of symptomatic
acute HIV between 52 and 92 percent, and more
than 85 percent of these patients have sought medical
attention for the acute viral syndrome.13,14
TIME COURSE
The usual time course from exposure to development
of symptoms is two to four weeks; however, an
incubation period as long as 10 months has been
reported.15 The onset of symptoms is usually abrupt,
and severe symptoms last an average of 1.5 to 2 weeks.
Like with mononucleosis, low-grade lethargy and
depression may persist for weeks to months.
OF ACUTE HIV INFECTION
Frequency of Common Symptoms in Acute HIV Infection
___________________________________________________________________________________________________________
Symptom No. Patients Percent
Fever
200
96
___________________________________________________________________________________________________________
Adenopathy
154
74
___________________________________________________________________________________________________________
Pharyngitis
146
70
___________________________________________________________________________________________________________
Rash
146
70
___________________________________________________________________________________________________________
Myalgia/arthralgia
112
54
___________________________________________________________________________________________________________
Diarrhea
67
32
___________________________________________________________________________________________________________
Headache
66
32
___________________________________________________________________________________________________________
Nausea/vomiting
56
27
___________________________________________________________________________________________________________
Neuropathy
13
6
___________________________________________________________________________________________________________
Encephalopathy
12
6
Adapted from Niu, MT, Stein, DS, Schnittman, SM, J Infect Dis 1993; 168:1490.
PAGE 4
Rapid HIV Testing in Emergency Departments
CONSTITUTIONAL SYMPTOMS
differential diagnosis
Fever in the range of 38C to 40C is almost always
present with symptomatic acute HIV infection.
Nontender lymphadenopathy involving axillary,
cervical, occipital and epitrochlear nodes develops in
the majority of patients in the second week of illness,
concomitant with the emergence of the HIV-specific
immune response.
The differential diagnosis of acute HIV infection
includes mononucleosis due to Epstein–Barr virus
(EBV) or cytomegalovirus, toxoplasmosis, rubella,
viral hepatitis, disseminated gonococcal infection, and
other viral infections. One key finding which helps
distinguish these disorders from HIV infection is
mucocutaneous ulceration. Mucocutaneous ulceration
is unusual in all of these entities, and when present
should raise the suspicion for acute HIV infection.
mucocutaneous disease
Sore throat is a frequent manifestation of acute HIV
infection. Painful mucocutaneous ulceration is one of
the most distinctive manifestations of the syndrome.
Shallow, well-demarcated ulcers may be found in the
oral mucosa, anus, penis, esophagus or vagina. One
theory holds that these ulcers represent the portal of
entry of HIV, or form of “chancre.”16
A generalized macular or maculopapular rash on the
upper thorax, collar region, face, scalp and extremities
may develop 48 to 72 hours after the onset of fever.
The palms and soles may also be affected. This rash
is most commonly non-pruritic.
GASTROINTESTINAL SYMPTOMS
Many patients with acute HIV infection complain of
nausea, vomiting, diarrhea, anorexia and weight loss
averaging 5 kilograms.
other
Rarely, patients with acute HIV infection can present
with opportunistic infections, including pneumocystis
jiroveci pneumonia (PCP), thrush, and others.
LABORATORY FEATURES
CBC results are consistent with acute viral
illness. Lymphopenia, atypical lymphocytosis and
monocytosis are common. Elevated liver enzymes,
mild anemia and thrombocytopenia have also
been described.
Rapid HIV Testing in Emergency Departments
DIAGNOSIS OF ACUTE HIV
Rapid tests designed to detect antibody are not
useful in detecting acute HIV infection, nor is the
Western Blot, as antibody to HIV is not present in
the face of acute infection. Again, written informed
consent is necessary in many states to perform any
test which may lead to the diagnosis of HIV. If
acute HIV infection is suspected, one should obtain
written informed consent, where necessary, and
send an HIV RNA PCR to measure the HIV viral
load. Alternatively, one could measure the level of
p24 antigen. In acute HIV infection, both the HIV
RNA and p24 antigen will typically be very high,
and diagnostic of HIV disease. A rapid test should
be done at this time also, though not to make the
diagnosis, but rather to determine this to be acute
infection versus ongoing infection. In the setting of
acute HIV, the rapid test will be negative. An HIV
medicine specialist should be consulted to follow-up
and interpret results.
RAPID HIV TESTING
There are four rapid HIV tests that are currently
approved by the FDA. These include:
• OraQuick Advance: can be used for testing on blood (sens. 99.6%, spec. 100%), plasma, and oral fluid (sens. 99.3%, spec. 99.8%)
• UniGold Recombigen: can be used for testing on blood (sens. 100%, spec. 99.7%) plasma and serum
PAGE 5
• Reveal G2: can be used for testing on plasma and serum
• Multispot HIV-1/HIV-2: can be used for testing on serum.
Oraquick Advance utilizing oral fluid or whole blood,
as well as UniGold Recombigen utilizing whole
blood, are both CLIA-waived, and the remainder
are classified as moderately complex. Oraquick costs
approximately $17.50 per test and external controls
must be purchased separately (approximately $25.00).
UniGold Recombigen costs $15.75 and controls also
must be purchased separately (approximately $26.00).
CONCLUSION
Survival benefits of HIV/AIDS treatments have been
impressive and improving steadily. However, new
infections are continuing at approximately the same
rate over the last decade and show no signs of abating.
This is primarily driven by the approximately 250,000
individuals in the United States who are HIV-infected
but unaware of that infection. Testing individuals for
HIV in the acute and primary care settings is hoped to
dramatically increase the awareness of individual HIV
status. We hope that wider screening of individuals
at point of care venues like emergency departments,
urgent care centers, and primary care offices will help
reduce the infection rate and improve survival.
DO YOU NEED HELP IMPLEMENTING
A TESTING PROGRAM IN YOUR HOSPITAL?
The Adolescent AIDS Program at Montefiore Medical Center in the Bronx,
in collaboration with the New York/New Jersey AIDS Education and
Training Center, has developed ACTS (Assess, Counsel, Test, Support),
a paradigm-shifting approach to HIV Counseling and Testing (C&T) that
is designed to help make C&T a more routine part of health care services
in various health care settings.
See for yourself how ACTS can make HIV testing a routine part of the care
you deliver by accessing the online ACTS tutorial and materials found at
www.hivgettested.com. In less than 2 hours, you will understand the ACTS
approach and how to put its easy-to-use tools to work in your practice. After you experience the tutorial, adapt the slide set as needed to train
your staff, or use it as a train the trainer tool. For more information call
(718) 882-0232.
PAGE 6
Rapid HIV Testing in Emergency Departments
ADDITIONAL RESOURCES
AIDS Education & Training Centers, National Resource Center
www.aidsetc.org
AIDS.Gov (provides information on types of HIV tests)
www.aids.gov/testing/types/index.html
CDC’s National HIV Testing Resource Website
www.hivtest.org
CDC’s Revised Recommendations for HIV Testing of Adults, Adolescents, and
Pregnant Women in Health-Care Settings
www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm
Food and Drug Administration (provides a list of HIV tests approved by the FDA)
www.fda.gov/cber/products/testkits.htm
New York/New Jersey AIDS Education & Training Center
www.nynjaetc.org
New York State Department of Health, AIDS Institute (provides HIV clinical guidelines)
www.hivguidelines.org/content.asp
New York State Department of Health, AIDS Institute (provides general HIV Information)
www.health.state.ny.us/diseases/aids
ACCREDITED
DVDs & VIDEOTAPES
Rapid HIV Testing & Diagnosing Acute HIV Infection
There is no fee for this resource.
Contact Jim Ybarra at (518) 262-4674 or ybarraj@mail.amc.edu to request a copy.
Rapid HIV Testing in Emergency Departments
PAGE 7
REFERENCES
1. Glynn M, Rhodes P. Estimated HIV prevalence in the
United States at the end of 2003. Presented at: 2005
National HIV Prevention Conference; June 12-15, 2005;
Atlanta, GA. Abstract T1-B1101.
2. Marks G, Crepaz N, Senterfitt JW, et al. Meta-analysis of
high-risk sexual behavior in persons aware and unaware they
are infected with HIV in the United States: implications for
HIV prevention programs. J Acquir Immune Defic Syndr.
2005: 39L446-53..
3. Kaiser Family Foundation 2006 Survey of Americans on
HIV/AIDS. http://www.kff.org/kaiserpolls/upload/7521.pdf.
Accessed 30 April 2007.
4. Branson B, Handsfield H. Revised Recommendations for
HIV Testing of Adults, Adolescents, and Pregnant Women
in Health Care Settings. MMWR. Sept 22, 2006/55(RR14);
1-17.
5. MMWR Missed opportunities for earlier diagnosis of HIV
infection – South Carolina, 1997-2005. Dec 1, 2006.
55(47) 1269-1272.
6. Mehta SD, Hall J, Lyss SB, Skolnik PR, Pearler LN,
Kharasch S. Adult and pediatric emergency department
sexually transmitted disease and HIV screening:
Programmatic overview and outcomes. Acad Emerg Med.
2007 Mar;14(3):250-8.
7. Lyss SB, Branson BM, Kroc KA. Couture EF, Newman DR,
Weinstein RA, Detecting Unsuspected HIV Infection with
a Rapid Whole-Blood HIV Test in an Urban Emergency
Department. J Acquir Immune Defic Syndr. 2007 Apr 1;
44(4):435-42.
9. Lyons MS, Lindsell CJ, Ledyard HK, Frame PT, Trott AT,
Emergency department HIV testing and counseling: an
ongoing experience in a low-prevalence area. Ann Emerg
Med. 2005 Jul;46(1):22-8.
10. Silva A, Glick NR, Lyss SB, Hutchinson AB, Gift TL, Pealer
LN, Broussard D, Whitman S. Implementing an HIV and
Sexually Transmitted Disease Screening Program in an
Emergency Department. Ann Emer Med. 2006 Nov 17;
[Epub ahead of print]
11. Kahn, JO, Walker, BD. Acute human immunodeficiency
virus type 1 infection. N Engl J Med 1998; 339-33.
12. Niu, MT, Stein, DS, Schnittman, SM. Primary human
immunodeficiency virus type 1 infection: Review of
pathogenesis and early treatment intervention in
humans and animal retrovirus infections. J Infect Dis
1993; 168-1490.
13. Tindal, B, Barker, S, Donovan, B, et al. Characterization
of the acute clinical illness associated with human
immunodeficiency virus infections. Arch Intern Med 1988;
148:945.
14. Schacker T, Collier, AC, Hughes, J. et al. Clinical and
epidemiologic features of primary HIV infection.
Ann Intern Med 1996; 125:257.
15. Ridzon, R, Gallagher, K, Ciesielski, C, et al. Simultaneous
transmission of human immunodeficiency virus and
hepatitis C virus from a needle-stick injury [see comments].
N Engl J Med 1997; 336:919.
16. Gaines, H, Von Sydow, M, Pehrson, PO, et al. Clinical
picture of primary HIV infection presenting as a glandular
fever-like illness. Br Med J 1988; 297:1363.
8. Haukoos JS, Witt MD, Coil CJ, Lewis RJ. The effect of
financial incentives on adherence with outpatient human
immunodeficiency virus testing referrals from the emergency
department. Acad Emerg Med. 2005 Jul;12(7):617-21.
PAGE 8
Rapid HIV Testing in Emergency Departments
s e l f a s s e s s m e n t te s t
Directions: Please select the BEST answer by circling
your response directly on this test. To obtain CME credit,
a minimum of 70% of the questions must be answered
correctly.
1) What percentage of HIV-infected individuals in
the United States is unaware of their infection? a. 10%
b. 50%
c. 25%
2) Some states require that written informed consent
be done prior to testing a patient for HIV, while
others do not.
a. True
b. False
3) New CDC guidelines for testing patients for HIV
recommend testing all individuals between the ages
of________.
a. 21 to 45
b. 18 to 65
c. 13 to 64
4) The method of universal testing of pregnant
women has reduced the rate of mother-to-child
HIV infection to less than 2%.
a. True
b. False
5) Earlier programs established to perform routine
HIV testing in Emergency Department settings
have found the rate of willingness to have a rapid
test to be between?
Rapid HIV Testing
in Emergency Departments
6) Studies have shown that the majority of people
experiencing an Acute Retroviral Syndrome from HIV
infection have sought medical attention. a. True
b. False
7) The usual time course from exposure to development of
symptoms of acute HIV infection is two to four weeks.
a. True
b. False
8) The Acute Retroviral Syndrome of HIV infection is very similar to mononucleosis. a. True
b. False
9) A rapid HIV antibody test will be positive in a patient
with acute HIV infection.
a. True
b. False
10) In order to diagnosis a patient with acute HIV infection,
it is necessary to order a HIV RNA PCR or p24 antigen,
because the antibody test will still be negative.
a. True
b. False
a. 20% to 35%
b. 40% to 70%
c. 100%
[ over ]
Rapid HIV Testing in State Emergency Departments
PAGE 9
Pr o gr a m Eva l u ati on & R e a der I n f or m atio n Form
To assure your receipt of CME credit, please mail your completed
self assessment test, program evaluation, reader information form
and HRSA participant information form (3 pages total) to:
Rapid HIV Testing
in Emergency Departments
Cathryn R. Corlew
Albany Medical College
47 New Scotland Avenue, Mail Code 158
Albany, NY 12208
A CME-Accredited Resource
Please allow 6-8 weeks for education credit processing. An
attendance certificate and self assessment test answer key will be
mailed to you at that time. If you have any questions, please contact
Cathryn Corlew at (518) 262-6864 or corlewc@mail.amc.edu.
Evaluatio n
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Yes
5
5
4
4
3
3
2
2
1
1
[
5 = Excellent 4 = Very good 3 = Good
2 = Fair 1 = Poor
]
No
Do you think that this resource will result in you implementing a rapid HIV testing program in your Emergency Department?
Yes
No
If no, what are the barriers that you foresee?_ ______________________________________________________________________
_ ______________________________________________________________________________________________________
_ ______________________________________________________________________________________________________
_ ______________________________________________________________________________________________________
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_ ______________________________________________________________________________________________________
_ ______________________________________________________________________________________________________
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Degree:
(i.e. MD, PA, NP, RN or LPN)
Emergency Department Name:
Work Address:
Phone_______________ Fax _______________ E-mail Address (if applicable):
Please proceed to the next page and complete the HRSA participant information form.
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Rapid HIV Testing in Emergency Departments
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