Evaluation of emergency department visits prior to an HIV diagnosis: Missed opportunities

Objective: There is a high rate of occult infection and late diagnosis in HIV. Hospital emergency depart-ments (ED) are an important point of health care. The present work aims to know the number of missed opportunities for HIV diagnosis occurring in the ED. Method: Retrospective multicenter cohort study that included all patients diagnosed with HIV infection in 2019 in 27 Spanish hospitals in 7 different autonomous communities. All ED consultation episodes in the 5 years prior to diagnosis were reviewed to find out the reason for consultation and whether this represented a missed opportunity for HIV diagnosis. Result: Seven hundred twenty-three patients were included, and 352 (48.7%; 95% CI: 45.1%-52.3%) had at least one ED visit during the 5 years prior to diagnosis (median 2; p25-p75: 1-4). One hundred and eigh-teen patients (16.3%; 95% CI: 13.8%-19.2%) had a missed diagnostic opportunity. The main consultations were drug use (145 [15%]), sexually transmitted infections (91 [9.4%]) and request for post-exposure HIV prophylaxis (39 [4%]). One hundred and fifty-five (42.9%) of the 352 had less than 350 CD4/mm3 when the HIV diagnosis was established. In patients with previous ED visits, the mean time to diagnosis from this visit was 580 (SD 647) days. Conclusions: Sixteen percent of patients diagnosed with HIV missed the opportunity to be diagnosed in the 5 years prior to diagnosis, highlighting the need to implement ED screening measures different from current ones to improve these outcomes.