ICTR in the News: Study Finds the Emergency Department Can Play a Key Role in Identifying Undiagnosed HIV Cases in Low Resource Settings
Posted by: Alexander Ward on: March 22, 2018 | Print This Page
The following article profiles work performed by ICTR researcher Bhakti Hansoti, M.B.Ch.B., Ph.D., assistant professor of emergency medicine at the Johns Hopkins University School of Medicine.
A Johns Hopkins-led study suggests HIV testing in a South African emergency department is an effective strategy to identify patients missed by current testing initiatives
Researchers at Johns Hopkins set out to quantify the burden of undiagnosed HIV infection in a South African emergency department and to evaluate the effectiveness of HIV testing in such a setting. The study was conducted during a three-month period in 2016 at Frere Hospital in the Eastern Cape. The team’s findings were recently published in PLOS ONE.
“This is a low resource area without electronic medical records or a patient track board to monitor patient status, and thus conducting research here is inherently difficult. Furthermore, patients come from a 60-mile radius and there are challenges to providing follow-up care,” says Bhakti Hansoti, M.B.Ch.B., Ph.D., assistant professor of emergency medicine at the Johns Hopkins University School of Medicine. “In many low resource settings, the emergency department is a safety net for patients who are often missed by the health system.” In doing this study, they captured a high volume of this unique and vulnerable patient population, she adds.
A total of 2,355 emergency department (ED) patients, most of whom presented to the ED due to a trauma injury, were approached by staff to receive HIV testing. Almost 73 percent of those patients accepted HIV testing. About 22 percent, or 400 patients, were HIV positive, including 115 patients, or about 6 percent, who were newly diagnosed with HIV infection. Researchers found the overall prevalence of HIV infection was twice as high in females compared to males, with about one in every three women having HIV.
“As a region, the Eastern Cape has one of the highest rates of HIV infection in the world,” says Thomas Quinn, M.D., professor of medicine at the Johns Hopkins University School of Medicine and the senior author of the paper. “This particular study is the first to document the full magnitude of HIV infection in the region, and the eagerness of the people to know whether they are infected with HIV. The government provides access to treatment, making diagnosis a critical component of care.”
However, both Quinn and Hansoti hope HIV testing will become commonplace in low resource emergency care settings. “We’re transitioning emergency care from a service focused only on stabilization and resuscitation to a health care venue that helps a difficult-to-reach population with preventative care and surveillance, such as HIV testing,” Hansoti says. “It’s time for a major paradigm shift for many hospitals and health systems as we define the role of emergency care in low resource environments.”
Additional authors on the study include David Stead and Andy Parrish of Walter Sisulu University and Frere and Cecilia Makiwane Hospitals in South Africa; Steven J. Reynolds, Andrew D. Redd and Madeleine M. Whalen of the Johns Hopkins University School of Medicine; and Nomzamo Mvandaba of Walter Sisulu University.
Research reported in this publication was supported by the South African Medical Research Council and, in part, by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health.