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HIV and Viral Hepatitis Screening
Uncomplicating ED Screening: Expert Insights for HIV, HCV, and HBV Screening on the Front Lines

Released: April 28, 2025

Expiration: April 27, 2026

Gaby Dashler
Gaby Dashler, MPH
Richard E. Rothman
Richard E. Rothman, MD, PhD, FACEP
Activity Information

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Key Takeaways
  • Simplified approaches to routine screening for HIV and HCV can be set up by leveraging existing systems of care.
  • Linkage to care in the emergency department can be as simple as helping the patient understand that HIV and HCV can easily be treated, and letting them know how they can access that treatment

As a thought leader in public health screening programs in emergency departments (EDs), what would you say to someone just starting out in developing an HIV and hepatitis C virus (HCV) screening program in their ED?

Richard E. Rothman, MD, PhD, FACEP: 
First, I’d start with why we want to screen. ED healthcare professionals (HCPs) take care of many patients with subacute or chronic problems that will impact their health long after their acute care visit, which influences the likelihood that they will have future urgent or emergent clinical problems.

Consider diabetes as a metaphor for HIV or HCV. A patient who has poorly controlled blood sugar comes into the ED with heart failure. If we treat their heart failure only and don’t address their blood sugar problems, that patient will likely come back to the ED with complications from diabetes, negatively impacting their individual health as well as placing extra stress on the ED and incurring additional costs to the health care system.

Chronic viral illnesses can be viewed similarly. If HIV or HCV go undiagnosed because they were not immediately recognizable as an emergency condition, that does a disservice both to the individual patient and to the healthcare system.

Also, screening is achievable, even in ED settings, given advances in testing methods and electronic medical records (EMR). Although implementing a public health screening program might be seen as a daunting task, at Johns Hopkins, we’ve found that simplified approaches can be established using existing resources. There are simple, rapid tests (both central lab and point of care) for HIV and HCV that can be performed during the ED encounter. Further, leveraging advances in automated EMR systems can help screening become an integrated part of routine ED care.

My message for ED administrators and HCPs is that it’s better to do something rather than nothing for the patients you’re taking care of. Don’t let the pursuit of perfection prevent you from trying. Look at the infrastructure that you have at your hospital and try to set up a simple model that works for your particular ED.

In instances where the ED itself will not be initiating care, what approaches can sites take to provide linkage to care?

Richard E. Rothman, MD, PhD, FACEP:
At the current time, since most EDs don’t have the capacity or training for initiating care for people newly diagnosed with HIV, my message is to find places within your hospital setting or your local community that you can refer patients to, just like you would for any other healthcare condition.

That could be done by directly reaching out to your local infectious disease clinic to engage their providers, offering patients appointments at an ED aftercare clinic (if that’s available), referring them to a community health clinic, or referring them back to their own HCP.

Regardless, the key is giving patients the information they need to be able to access care and letting them know that it’s important for their health to follow up promptly. Letting patients know that hepatitis C can be fully cured and HIV can be well-controlled, as long they get into care, is the primary message.

What are your thoughts on adding hepatitis B virus (HBV) testing to your protocols?

Richard E. Rothman, MD, PhD, FACEP:
I think the same health care imperatives that exist for HIV and HCV exist for HBV, but HBV testing hasn’t been as heavily promoted in the public health system.

Given the fact that we have systems and programs in place now to facilitate universal screening for HIV and HCV, EDs can also consider leveraging those same systems for testing and screening for HBV.

What timeframe do you use for HIV and HCV retesting at Johns Hopkins? For patients with prior HCV screening who are not considered high risk, do you retest?

Gaby Dashler, MPH:
At Johns Hopkins Hospital, our smart EMR algorithm prompts HCPs to offer HIV testing based on CDC recommendations. That is, universal screening is offered if a patient has never been tested. Retesting is offered if a patient has ongoing risk and has not been tested in the past year, or if a patient presents with sexually transmitted infection-related complaints.

For HCV, we also follow the CDC recommendation for one-time screening. That is, if a patient has no record of prior HCV testing in our system, they are offered the opportunity to be tested during their ED visit. In addition, we have an EMR algorithm which includes questions to assess patient’s ongoing HCV risk (based on CDC risk criteria) to help determine if an individual patient could benefit from repeat testing.

On an interpersonal level, how would you describe the impact of screening programs in the ED?

Gaby Dashler, MPH:
Some of the most impactful moments that I’ve seen in the ED are when we find a patient with an acute HIV infection. In some of these cases, the patient may be coming to the ED for an unrelated acute issue. The 4th generation tests we use allow very early detection of an infection and permit us to initiate antiretroviral therapy immediately, when treatment can be most helpful. This significantly improves those individuals’ long-term health outcomes and reduces risk of transmission to others.

It’s incredibly rewarding to know that our efforts have resulted in identifying many patients’ infections at a critical point, before the infection resulted in long term health problems. This is something that may not have happened without our routine ED screening program.

Importantly, we know that many of these patients were not otherwise engaged with a regular HCP, anywhere in the healthcare system. Without routine ED screening, those patients may not be diagnosed until much later in the course of their infections, after they have experienced complications and when it has become more challenging to treat them. These experiences highlight the real-world value of integrating HIV testing into emergency care.

What’s on the horizon for screening, re-engagement, and linkage to care?

Gaby Dashler, MPH:
Looking ahead, I think there are ample opportunities to leverage artificial intelligence and large language models (LLMs) to make screening and testing easier. For example, automated, real-time analyses of EHR data, including demographics, chief complaints, and medical history, could result in more efficient and accurate identification of patients in our ED who are at elevated risk for HIV and HCV, who would benefit from repeat screening (in addition to the recommended one-time universal screening).

In terms of re-engagement and linkage to care, LLMs could be employed in the future, to scan clinical notes and help the clinical providers offer those patients who are disengaged from care, or who have experienced lapses in follow-up an opportunity to get back into regular care.

Your Thoughts
Do you plan to (or do you already) offer routine screening for HCV and HIV in your practice? Why or why not? Leave a comment to join the discussion!