The feasibility and yield of Hiv screening among adult trauma patients attending emergency department At Muhimbili National Hospital Dar Es Salaam, Tanzania

Abstract

ABSTRACT Introduction:Human Immunodeficiency Virus (HIV) remains the major global health problem, affecting over 36.7 million people, causing over 1.1 million deaths in 2015. In Tanzania, the prevalence of HIV was estimated to be 4.8% by the end of August 2017. The World Health Organization (WHO) and Tanzanian National Guidelines for HIV and acquired immune deficiency syndrome (AIDS) management, require provider initiated testing and counseling for HIV at the point of contact, however there has been no study done in Tanzania looking the feasibility of routine HIV testing and its yield in among acutely ill patients in the Emergency Department (ED).

Aim of the study:The objective of the study wasto determine the feasibility and yield of HIV screening among adult trauma patients attending the Emergency Department (ED) at Muhimbili National Hospital (MNH).

Materials and Methods: This was a prospective cohort study of consecutive adult trauma patients presenting to ED-MNH between March 2017 and September 2017.Eligible patients who consented to be in the study received pre and post HIV testing counseling by a trained research assistant. They were asked if they would undergo point of care (POC) HIV testing. Testing was done as per the current Tanzanian National Guidelines for HIV and AIDS Management.A finger prick blood sample was tested with SD Bioline; a negative result was recorded as free of HIV, and all positive results were confirmed by a positive POC UNIGOLD test. Negative UNIGOLD tests were considered inconclusive and confirmation was done by taking their blood sample to the central laboratory for HIV ELISA testing.Structured case report forms were completed, documenting demographic information, acceptability of the test, test results and readiness to receive test results.The study data was summarized with descriptive statistics, including means and standard deviations, medians and interquartile ranges (IQR), counts, percentages, and 95% confidence intervals, as appropriate.

Results: We enrolled326 (11.5%)out of 2,848 trauma patients screened for eligibility to participate in study.The median age was 33 (IQR 25-42 years) and 248 (76.0%) patients were male.Of those enrolled in the study, 250 (76.7%) patients agreed to be tested for HIV, and 247 (98.8%) were ready to receive their test results after testing. Out of those tested, 14 (5.6%) tested positive for HIV at EMD. None of the enrolled patient were tested for HIV by the physician as part of their regular care.Two months post hospital discharge, 6 (42.8%), of the HIV positive patients had attended Care and Treatment Clinics (CTC) for HIV treatment. Conclusion & Recommendations:Routine HIV screening among adult trauma patients is feasible, acceptable and results in identification of previously undiagnosed cases of HIV and subsequent follow up in continuous HIV and AIDS care. Future studies should focus on factors affecting the linkage to CTC among HIV positive patients identified at the ED.