Background: Human immunodeficiency virus (HIV) infection continues to expand
worldwide, and a significant proportion of infection is still undiagnosed. Recent studies have addressed
the impact and feasibility of ‘opt-out’ HIV screening in Emergency Departments (EDs) in
urban settings at high HIV prevalence, whereas little is known about the yield of implementing ‘targeted’
HIV testing, especially in low-prevalence areas.
Objective: The present study undertakes a scoping review of research carried out on the implementation
of targeted HIV screening of adult in EDs to determine the impact, feasibility and acceptability
of HIV testing in different HIV prevalence settings.
Design: Online databases (EMBASE, MEDLINE) were used to identify papers published between
2000 to 2020. A three-concept search was employed with HIV (HIV, Human immunodeficiency
virus infection, HIV infections), targeted testing (Target, screening or testing) and emergency
medicine (Emergency Service, emergency ward, A&E, accident and emergency or Emergency Department)
(28th February 2020). Only full-text articles written in English, French, Spanish or Italian
and using impact and/or feasibility and/or acceptability of the program as primary or secondary outcomes
Results: The search provided 416 articles. Of these, 12 met inclusion criteria and were included in
the final review. Most of the included studies were carried out in the United States (n=8; 67%) and
in areas of high HIV prevalence (n=11; 92%). Three (20%) were randomized control studies.
While the rate of newly diagnosed HIV cases varied widely (0.03-2.2%), likely due to methodological
heterogeneity between studies, the linkage of new HIV diagnosis was often high (80-100%)
and median CD4+ cell count was always greater than 200 cells per microliter. Targeted HIV screening
was found to be cost-effective (out of 2 studies) and well accepted by participants (out 2
Conclusions: Targeted HIV screening at the ED can be impactful, feasible and well accepted, but
often requires extra funding and staff. Most previous work has focused on areas of high disease prevalence.