Indicator condition-based and risk-factor guided HIV testing in the emergency department: An effective strategy to increase new diagnoses in Italy

Objectives This study evaluated the feasibility and effectiveness of clinical indicator conditions (ICs)-guided and epidemiological risk factors (RF)-based provider-initiated HIV testing in Italian urban Emergency departments (EDs) within the current opt-in legal framework. Methods A multicenter cross-sectional study was conducted from September 2022 to September 2023 in the EDs of two urban hospitals in Rome and Milan. Adults with one or more pre-defined ICs and/or RFs were offered HIV testing. Demographic, clinical and historical data were collected, and multivariable logistic regression was used to identify predictors of HIV test reactivity. Results Among 826 enrolled participants, 12 new HIV diagnoses were made, yielding a reactivity rate of 1.45% (95% CI 0.82-2.54). ICs associated with test reactivity included mononucleosis-like illness, seborrheic dermatitis/exanthema, and pneumonia. Key RFs associated with positivity included being a migrant from a high-HIV-endemic country, MSM status, and injection drug use. Most newly diagnosed individuals had CD4+ T lymphocytes counts <350 cells/µL, and missed opportunities for earlier testing were identified in 66.7% of evaluable cases. Conclusion Provider-initiated HIV testing in EDs guided by ICs and RFs is feasible and effective within the Italian opt-in framework, enhancing early HIV case detection, supporting broader implementation as part of national testing strategies.