Aim of the study

To evaluate human immunodeficiency virus (HIV) and hepatitis C virus (HCV) testing strategies in a specialist infectious diseases emergency department (ED).

Material and methods

Five sub-studies (2013-2018; PEP cohort 2008-2016) at one specialist infectious diseases hospital in Warsaw: retrospective HIV testing in mononucleosis-like syndrome (MONO) inpatients (Study 1); prospective HIV testing of ED patients with MONO or community-acquired pneumonia (CAP) (Study 2); cross-sectional HCV screening of unselected ED patients (Study 3); prospective rapid anti-HCV testing in patients with risk factors (Study 4); and a retrospective post-exposure prophylaxis cohort with logistic regression (Study 5).

Results

HIV prevalence was 5.5% (95% CI: 1.5-13.6%) among MONO inpatients (Study 1) and 3.5% (95% CI: 2.2-5.2%) in MONO/CAP outpatients (Study 2), with the highest prevalence in CAP (11.1%; 95% CI: 4.6-21.6%). HCV seroprevalence was 0.5% in unselected patients but 1.68% (95% CI: 1.09-2.47%) among patients with risk factors, reaching 15.8% in people who inject drugs (PWID). In Study 5 (n = 3,593), independent predictors of anti-HCV positivity were injecting drug use (OR = 162.60, 95% CI: 38.55-1139.85), male-to-male sexual contact (OR = 3.59, 95% CI: 1.01-22.87), and age (OR = 1.05/year). Median delay from HCV diagnosis to first specialist visit was 168 days; 28% required urgent admission for decompensated liver disease.

Conclusions

Indicator condition-guided HIV testing and risk factor-based HCV testing in a specialist ED yield detection rates substantially above those in the general population. The findings are most directly translatable to specialist ID emergency departments and require validation in general ED settings. The 168-day diagnosis-to-specialist delay identifies a major gap in the HCV care pathway.