Characterisation of new HIV diagnoses achieved in emergency departments using an opt-in strategy, Catalonia, Spain, July 2021 to March 2024

BACKGROUNDHIV screening strategies in alternative settings, such as emergency departments (EDs), aim to increase diagnosis of occult infections and achieve 95-95-95 targets for 2030.AIMTo assess the effectiveness of an opt-in HIV screening strategy in EDs based on six clinical scenarios from a 2020 Spanish consensus document, while examining patient characteristics and linkage to-care.METHODSThis descriptive, multicentre, retrospective study analysed epidemiological, clinical, and linkage-to-care data of individuals aged ≥ 18 years newly diagnosed with HIV between July 2021 and March 2024 in 17 EDs covering 73% of the population in Catalonia, Spain.RESULTSFrom 23,105 HIV serologies performed, there were 172 new diagnoses (positivity rate: 0.7%). Of these, 88.4% (152/172) were assigned male at birth, had a median age of 39 years (IQR: 30-50), and 47.9% (81/169) were Spanish. Sexual transmission was reported in 75.6% (130/172) of cases, with 55.5% (81/146) heterosexual. Fiebig stage data, available in 78.5% (135/172) of cases, showed 57.8% (78/135) had acute infection. Advanced HIV was found in 24.2% (30/124). Diagnoses related to the six clinical scenarios accounted for 54.6% (94/172) of cases. For all new diagnoses, 82.0% (137/167) were linked to specialised healthcare and started antiretroviral treatment within 9 days (IQR: 4-17), with no significant differences regarding urban/rural hospital coverage areas.CONCLUSIONAn opt-in HIV screening strategy in the ED is feasible and effective, especially in detecting highly transmissible patients with acute infection. However, one in five newly diagnosed individuals remained untreated, highlighting the need for improved linkage to care.