Making testing routine would multiply the number of emergency room screenings at University Hospital by 700 percent

Of the estimated 1.2 million Americans living with Human Immunodeficiency Virus (HIV), one in seven are unaware that they are infected. Rutgers New Jersey Medical School believes routine screening for HIV can significantly reduce that number in the Newark area and has been awarded a $300,000 private grant to start screening all patients who register in the emergency department at University Hospital, NJMS’ teaching hospital.

All emergency room patients at University Hospital would be offered HIV testing.

“We hope this will greatly increase the number of people being diagnosed with HIV earlier on in their disease to help them connect with care,” said Shobha Swaminathan, an assistant professor in the division of infectious diseases at NJMS’ Department of Medicine. She plans to launch the initiative in March or April.

While patient consent would be required, the screening would be made available for the first time to all patients treated in the hospital’s emergency room, the primary venue for admissions.

“Through this program, ideally, we’d like to make sure that anybody we have seen in the emergency room who is newly identified will be connected to care within one to two business days at an HIV clinic,” Swaminathan said. “Once linked to care, the goal would be for them to start medication to treat HIV as soon as possible.”

The annual grant was awarded by Gilead Sciences Inc., of Foster City, California, for up to three years. Making the HIV testing routine would multiply the number of emergency room screenings at University Hospital by 700 percent, according to NJMS.

Newark is one of the most severely impacted U.S. communities by HIV/AIDS. By the end of 2013, nearly 14,600 residents had been diagnosed with HIV/AIDS, of whom 8,741 died. The federal government is now finalizing a rule that would make HIV screening eligible for Medicare funding. Because 16 percent of University Hospital’s patients are Medicare eligible, the federal change could provide one source of long-term funding once the grant ends.

“Implementing routine HIV testing in the emergency department of a major hospital serving the Newark community is a huge opportunity to increase the number of people that know their HIV status, connect them to care and treatment, decrease their viral load and the overall viral load of the community,” Swaminathan said in public comments submitted in support of the Medicare change.

HIV headshot
Shobha Swaminathan sees early detection as key to HIV treatment.
Photo: LaCarla Donaldson

She explained that the stigma once attached to HIV testing has eroded over time due to greater awareness of HIV and AIDS, and the effectiveness of antiretroviral therapy, which can keep the level of HIV virus low.

“That being said,” she added, “there is still a significant amount of social stigma in many pockets of the population. Many of those pockets include undocumented patients, patients without health insurance, and immigrants who don’t have access to routine health care, which is why getting them tested in the emergency room may be a good way to make sure that they are able to get tested and get linked to care regardless of their immigration issues.”

Swaminathan said early diagnosis and treatment is critical to combat HIV, which destroys the CD4 cells, or “T-cells,” a type of white blood cell that helps protect the body from infection.The sooner HIV is arrested, the more likely the patient can restore their T-cell count to healthy levels, she said. In addition, low T-cell counts and lack of treatment has been shown to lead to pneumonia and cardio-vascular disease, she said.