{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T05:26:05Z","timestamp":1781933165247,"version":"3.54.5"},"reference-count":36,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Undiagnosed HIV infection remains the main driver of new HIV cases in Western countries. Emergency Departments (EDs) offer a key opportunity for detection. In 2020, Spanish emergency and infectious diseases societies recommended an opt\u2010in strategy for targeted conditions for HIV testing in EDs. This study evaluates the efficacy of three strategies for targeted HIV testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twelve Spanish EDs, selected based on predefined structural criteria, assessed HIV testing from April to June 2024. Hospitals applied: no strategy (control, three EDs), an educational programme (strategy A, three EDs), strategy A plus preconfigured electronic orders (strategy B, three EDs) or strategy B plus electronic alerts in medical records (strategy C, three EDs). The impact on HIV testing was measured overall and by targeted condition, using absolute differences with 95% confidence intervals (CIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 612\u2009909 ED visits, 210\u2009039 occurred in control hospitals (1232 patients [0.59%] had targeted conditions), 172\u2009806 in hospitals applying strategy A (1497 [0.87%]), 132\u2009835 in strategy B hospitals (1761 [1.33%]) and 97\u2009229 in hospitals applying strategy C (1269 [1.31%]). Testing rates were 0.16%, 0.38%, 1.17% and 2.16% in the control, and strategy A, B and C EDs., respectively. Among patients with targeted conditions, testing reached 13.1%, 22.9%, 30.7% and 78.1%. Compared to no strategy, testing increased by 0.22% (95% CI\u2009=\u20090.18\u20130.25) with strategy A, 0.79% (95% CI\u2009=\u20090.73\u20130.86) with B, and 0.98% (95% CI\u2009=\u20090.88\u20131.09) with C. In targeted conditions, testing rose by 9.8%, 7.8% and 47.5% for strategies A, B and C, respectively. All strategies improved testing in sexually transmitted infections (STI), meningitis\/neurological syndromes and community\u2010acquired pneumonia (CAP); strategy C also increased testing in herpes zoster (HZ) and post\u2010exposure prophylaxis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>All the strategies evaluated enhanced targeted HIV testing, especially strategy C (electronic alerts), which was associated with the highest testing rates observed, particularly in STI, CAP and HZ.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.70074","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T12:29:48Z","timestamp":1752582588000},"page":"1429-1444","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of three different interventions designed to improve the implementation of an opt\u2010in targeted strategy of <scp>HIV<\/scp> testing in emergency departments"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4329-9802","authenticated-orcid":false,"given":"Juan Gonz\u00e1lez","family":"del Castillo","sequence":"first","affiliation":[{"name":"Emergency Department IdISSC, Universidad Complutense  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bego\u00f1a","family":"Espinosa","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital General doctor Balmis de Alicante  Alicante Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayra","family":"Cabrera","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Universitario Dr. Negr\u00edn  Gran Canaria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3825-8384","authenticated-orcid":false,"given":"Mar\u00eda Teresa S\u00e1nchez","family":"Moreno","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Universitario Cl\u00ednico de Valencia  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pl\u00e1cido","family":"May\u00e1n","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Cl\u00ednico Universitario de Santiago  Santiago de Compostela Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6844-8707","authenticated-orcid":false,"given":"Alexis","family":"Rebollo","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Universitario de Bellvitge  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9866-4259","authenticated-orcid":false,"given":"Julio Javier","family":"Gamazo","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Universitario de Galdakao  Bilbao Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5353-1628","authenticated-orcid":false,"given":"Hugo Martinez","family":"Faya","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Universitario de Navarra  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Esperanza Puga","family":"Montalvo","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Universitario San Cecilio  Granada Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isidro","family":"Baez","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Universitario Nuestra Se\u00f1ora de la Candelaria  Santa Cruz de Tenerife Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roc\u00edo","family":"de Paz","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital del Mar  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4778-3247","authenticated-orcid":false,"given":"Javier","family":"Caba\u00f1as","sequence":"additional","affiliation":[{"name":"Emergency Department Complejo Hospitalario Universitario de Toledo, IDISCAM  Toledo Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3914-2383","authenticated-orcid":false,"given":"Jes\u00fas \u00c1lvarez","family":"Manzanares","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Universitario Rio Hortega  Valladolid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d2scar","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"Emergency Department Hospital Cl\u00ednic, IDIBAPS, Universitat de Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Emergency HIV Network Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Global information and education on HIV and AIDS. 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Accessed February 1 2025.https:\/\/cne.isciii.es\/documents\/d\/cne\/informe-vih_sida_2023_nov-2024"},{"key":"e_1_2_12_6_1","first-page":"434","article-title":"Level of impact on the public health of universal human immunodeficiency virus screening in an emergency department","volume":"35","author":"Reyes\u2010Urue\u00f1a J","year":"2017","journal-title":"Enferm Infecc Microbiol Clin"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2025.101243"},{"key":"e_1_2_12_8_1","article-title":"HIV testing uptake according to opt\u2010in, opt\u2010out or risk\u2010based testing approaches: a systematic review and meta\u2010analysis","volume":"7","author":"Musarandega R","year":"2022","journal-title":"BMJ Glob Health"},{"issue":"4","key":"e_1_2_12_9_1","first-page":"511","article-title":"Exploring missed opportunities for earlier HIV diagnosis within routinely collected HIV surveillance data","volume":"55","author":"Begier EM","year":"2010","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"e_1_2_12_10_1","article-title":"The impact of provider\u2010initiated HIV testing and counselling and integration of HIV care on access to HIV testing and treatment in South Africa: a controlled before\u2013after study","volume":"15","author":"Leon N","year":"2022","journal-title":"Glob Health Action"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.12474"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(23)00117-0"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(23)00183-2"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000003750"},{"key":"e_1_2_12_15_1","first-page":"204","article-title":"Efficiency of screening for human immunodeficiency virus infection in emergency departments: a systematic review and meta\u2010analysis","volume":"34","author":"Gonz\u00e1lez Del Castillo J","year":"2022","journal-title":"Emergencias"},{"key":"e_1_2_12_16_1","first-page":"416","article-title":"Recommendations for the early diagnosis of suspected human immunodeficiency virus infection in the emergency department and the referral of patients for follow\u2010up: a consensus statement of the Spanish Society of Emergency Medicine (SEMES)","volume":"32","author":"Gonz\u00e1lez Del Castillo J","year":"2020","journal-title":"Emergencias"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEJ.0000000000001078"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.37201\/req\/085.2022"},{"key":"e_1_2_12_19_1","first-page":"188","article-title":"Impact of specialized training for emergency department nurses screening or undetected HIV infection: the \u201cUrg\u00e8ncies VIHgila\u201d project experience","volume":"36","author":"Mir\u00f3 E","year":"2024","journal-title":"Emergencias"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEJ.0000000000001229"},{"key":"e_1_2_12_21_1","first-page":"447","article-title":"New recommendations of Spanish Society of Emergency Medicine (SEMES) for emergency department diagnosis of HIV infection based on results from Spain's \u201cLeave Your Mark\u201d program","volume":"36","author":"Gonz\u00e1lez del Castillo J","year":"2024","journal-title":"Emergencias"},{"key":"e_1_2_12_22_1","unstructured":"Manuel de Codificaci\u00f3n CIE\u201010\u2010ES Diagn\u00f3sticos.Ministerio de Sanidad Servicios Sociales e Igualdad. 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Accessed March 1 2025.https:\/\/www.sanidad.gob.es\/ciudadanos\/enfLesiones\/enfTransmisibles\/sida\/docs\/GuiaRecomendacionesDiagnosticoPrecozVIH.pdf"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0052845"},{"issue":"10","key":"e_1_2_12_32_1","first-page":"614","article-title":"Improving the evidence for indicator condition\u2010guided HIV testing in Europe: results from HIDES II","volume":"19","author":"Raben D","year":"2018","journal-title":"HIV Med"},{"key":"e_1_2_12_33_1","unstructured":"Public Health England.Routine opt\u2010out testing for bloodborne viruses in emergency departments: early findings from the national HIV opt\u2010out programme. Accessed March 1 2025.https:\/\/www.gov.uk\/government\/publications\/hiv-testing-in-emergency-departments"},{"key":"e_1_2_12_34_1","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(23)00117-0","article-title":"Feasibility and effectiveness of opt\u2010out testing for HIV in UK emergency departments","volume":"10","author":"Sullivan AK","year":"2023","journal-title":"Lancet HIV"},{"key":"e_1_2_12_35_1","unstructured":"British HIV Association.Ethical considerations in routine opt\u2010out HIV testing in emergency settings. BHIVA guidelines. 2023. Accessed March 1 2025.https:\/\/www.bhiva.org\/guidelines"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010019\u201051128\u20106"},{"issue":"10","key":"e_1_2_12_37_1","first-page":"614","article-title":"Balancing efficiency and cost\u2010effectiveness in HIV screening: lessons from opt\u2010in and opt\u2010out strategies","volume":"19","author":"Raben D","year":"2024","journal-title":"HIV Med"}],"container-title":["HIV Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hiv.70074","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T10:45:13Z","timestamp":1756723513000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hiv.70074"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":36,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1111\/hiv.70074"],"URL":"https:\/\/doi.org\/10.1111\/hiv.70074","archive":["Portico"],"relation":{},"ISSN":["1464-2662","1468-1293"],"issn-type":[{"value":"1464-2662","type":"print"},{"value":"1468-1293","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]},"assertion":[{"value":"2025-03-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}