Abstract
Objective
We sought to evaluate the performance of an abbreviated version of the Denver HIV
Risk Score in 2 urban emergency departments (ED) with known high undiagnosed HIV prevalence.
Methods
We performed a secondary analysis of data collected prospectively between November
2005 and December 2009 as part of an ED-based nontargeted rapid HIV testing program
from 2 sites. Demographics; HIV testing history; injection drug use; and select high-risk
sexual behaviors, including men who have sex with men, were collected by standardized
interview. Information regarding receptive anal intercourse and vaginal intercourse
was either not collected or collected inconsistently and was thus omitted from the
model to create its abbreviated version.
Results
The study cohort included 15184 patients with 114 (0.75%) newly diagnosed with HIV infection. HIV prevalence was
0.41% (95% confidence interval [CI], 0.21%-0.71%) for those with a score less than
20, 0.29% (95% CI, 0.14%-0.52%) for those with a score of 20 to 29, 0.65% (95% CI,
0.48%-0.87%) for those with a score of 30 to 39, 2.38% (95% CI, 1.68%-3.28%) for those
with a score of 40 to 49, and 4.57% (95% CI, 2.09%-8.67%) for those with a score of
50 or higher. External validation resulted in good discrimination (area under the
receiver operating characteristic curve, 0.75; 95% CI, 0.71-0.79). The calibration
regression slope was 0.92 and its R2 was 0.78.
Conclusions
An abbreviated version of the Denver HIV Risk Score had comparable performance to
that reported previously, offering a promising alternative strategy for HIV screening
in the ED where limited sexual risk behavior information may be obtainable.
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Article Info
Publication History
Published online: March 06, 2014
Accepted:
February 25,
2014
Received in revised form:
February 22,
2014
Received:
January 20,
2014
Footnotes
☆Funding: Supported, in part, by an independent scientist award (K02HS107526) from the Agency for Healthcare Research and Quality and an investigator-initiated grant ( R01AI106057 ) from the National Institute of Allergy and Infectious Diseases to Dr Haukoos.
☆☆Conflicts of Interest: None declared.
★Meeting: Presented in part at the 2011 Society for Academic Emergency Medicine Annual Meeting, Boston, MA, June 1 to 5, 2011.
★★Author contributions: JSH and Y-HH conceived and designed the study. JSH and Y-HH provided statistical advice on study design and Y-HH analyzed the data. Y-HH and JSH interpreted the results and Y-HH drafted the manuscript. RER and JSH contributed substantially to its revision. Y-HH takes responsibility for the manuscript as a whole.
Identification
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
