Yield and disparities in newly diagnosed HIV identified through a universal emergency department-based screening program in South Florida.

Abstract

HIV disproportionately affects populations by age, sex/gender, race/ethnicity, and transmission mode. This study evaluated the yield of new HIV diagnoses through a universal emergency department (ED) -based screening program in South Broward County, Florida, and examined disparities across demographic and behavioral subgroups. A retrospective cohort study was conducted using electronic health records from six EDs within a single public, non-profit healthcare system. Between July 2018 and February 2024, all patients aged ≥18 years were offered free opt-out HIV combination assay testing. Patients with known HIV infection or who declined testing were excluded. Annual case detection rates were calculated, and year-adjusted Poisson regression with annual testing volume as an offset estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Among 111,758 tests, 671 were positive, yielding a positivity rate of 0.60% and an annual case detection rate of 600 per 100,000 patients screened. Case detection was significantly higher among males than females (IRR 1.83, 95% CI 1.56-2.15) and among Black patients than White (IRR 4.28, 95% CI 3.45-5.31) or Hispanic patients (IRR 3.56, 95% CI 2.91-4.34). These findings support continued universal opt-out ED-based HIV screening in high-burden communities while emphasizing persistent demographic disparities in newly diagnosed HIV.