The Impact of Nontargeted HIV Screening in Emergency Departments and the Ongoing Need for Targeted Strategies: Comment on “Modest Public Health Impact of Nontargeted Human Immunodeficiency Virus Screening in 29 Emergency Departments”

Early identification of human immunodeficiency (HIV) infection remains a critical public health priority. In the United States, approximately 240 000 individuals remain undiagnosed and 56 000 new infections occur annually.¹ To identify HIV-infected persons who are unaware of their status, the Centers for Disease Control and Prevention (CDC) has recommended “routine” (nontargeted) opt-out HIV screening in healthcare settings, including emergency departments (EDs), because EDs are considered the most common site of missed opportunities for diagnosing HIV infection.^2,3 More than 120 million ED visits occur annually in the United States,⁴ and a large proportion of patients who are at risk of acquiring HIV infection use EDs as their primary source of care. What remains unknown, however, is whether nontargeted HIV screening is the most effective or efficient means to identify patients with HIV infection or whether other approaches, such as targeting screening to those with identifiable risk factors, may be more effective.