HIV and HCV Screening in the ED EMRA

HIV and HCV Screening in the ED

Jan. 15, 2026

The CDC and ACEP both recommend opt-out screening for HIV in most emergency departments, though this practice is far from widespread. Host Peter Lorenz, MD, sits down with Emory’s Emma Sizemore, MD, MPH, to discuss the important public health role of emergency departments and her experience implementing an opt-out HIV and HCV screening program.

Show Notes

Host

Peter Lorenz, MD

Christiana Care
EM/IM Combined Residency Class of 2027
EMRA*Cast Episodes

Guest

Emma Sizemore, MD, MPH

Assistant Professor, Department of Emergency Medicine
Emory University School of Medicine

OVERVIEW

The CDC and ACEP both recommend opt-out screening for HIV in most emergency departments, though this practice is far from widespread. Host Peter Lorenz, MD, sits down with Emory University's Emma Sizemore, MD, MPH, to discuss the important public health role of emergency departments and her experience implementing an opt-out HIV and HCV screening program.

Discussion Question

Does your emergency department have an opt-out HIV screening program? What would it take to implement one?

Summary

The CDC recommended not-targeted HIV testing in the ED when the regional prevalence is >0.1%^1,6
- The national prevalence is about 0.4%
- ACEP supports this recommendation^2,7
Targeted testing has not been shown to be superior and non-targeted testing is cost-effective^1,3,4,8
There should be integration into the larger system of care⁷

TAKE-HOME POINTS

Emergency departments represent a large volume of patient contact and a key opportunity for screening.
There is still a large amount of undiagnosed HIV and HCV. Both diseases have excellent treatment options.
Opt-out HIV screening is guideline-recommended.
HIV treatment should never be cost-prohibitive.
CDC recommended HIV ½ Ag/Ab combo testing. This is available as a rapid test.^1,5

References

Haukoos JS, Hopkins E, Conroy AA, et al. Routine opt-out rapid HIV screening and detection of HIV infection in emergency department patients. JAMA. 2010;304(3):284-292.
Weber W, Heins A, Jardine L, Stanford K, Duber H. Principles of Screening for Disease and Health Risk Factors in the Emergency Department. Ann Emerg Med. 2023;81(5):584-591.
Haukoos JS, Lyons MS, Rothman RE, et al. Comparison of HIV Screening Strategies in the Emergency Department: A Randomized Clinical Trial. JAMA Netw Open. 2021;4(7):e2117763.
Mwachofi A, Fadul NA, Dortche C, Collins C. Cost-effectiveness of HIV screening in emergency departments: a systematic review. AIDS Care. 2021;33(10):1243-1254.
US Preventive Task Force. Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;321(23):2326-2336.
Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. CDC Morbidity and Mortality Weekly Report. Sept. 22, 2006;55(RR14):1-17.
ACEP Policy Statement. HIV Testing and Screening in the Emergency Department. Ann Emerg Med. 2014;64(5):563.
Brown J, Shesser R, Simon G, et al. Routine HIV screening in the emergency department using the new US Centers for Disease Control and Prevention Guidelines: results from a high-prevalence area. J Acquir Immune Defic Syndr. 2007;46(4):395-401.
AIDSVu. Understanding HIV Where You Live. Available at https://aidsvu.org/.

HIV and HCV Screening in the ED