Highlights
- •Current HIV screening programs do not prioritize patients already known to be HIV/HCV positive.
- •A significant number of prior positive patients require confirmatory testing and linkage to care.
- •We used an electronic health record system to alert staff of the need for these health services.
- •This “proof of concept” highlights this patient subgroup and a new area of research.
Abstract
Objectives
Routine emergency department (ED) HIV or HCV screening may inadvertently capture patients
already diagnosed but does not specifically prioritize identification of this group.
Our objective was to preliminarily estimate the volume of this distinct group in our
ED population through a pilot electronic health record (EHR) build that identified
all patients with indications of HIV or HCV in their EHR at time of ED presentation.
Methods
Cross-sectional study of an urban, academic ED's HIV/HCV program for previously diagnosed
patients August 2017–July 2018. Prevention program staff, alerted by the EHR, reviewed
records and interviewed patients to determine if confirmatory testing or linkage to
care was needed. Primary outcome was total proportion of ED patients for whom the
EHR generated an alert. Secondary outcome was the proportion of patients assessed
by program staff who required confirmatory testing or linkage to HIV/HCV medical care.
Results
There were 65,374 ED encounters with 5238 (8.0%, 95% CI: 7.8%–8.2%) EHR alerts. Of
these, 3741 were assessed by program staff, with 798 (21%, 95% CI: 20%–23%) requiring
HIV/HCV confirmatory testing or linkage to care services, 163 (20%) for HIV, 551 (69%)
for HCV, and 84 (11%) for both HIV and HCV services.
Conclusions
Patients with existing indication of HIV or HCV infection in need of confirmatory
testing or linkage to care were common in this ED. EDs should prioritize identifying
this population, outside of routine screening, and intervene similarly regardless
of whether the patient is newly or previously diagnosed.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D; use, select 'Corporate R&D; Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Emergency departments at the crossroads of intersecting epidemics (HIV, HCV, injection drug use and opioid overdose)-estimating HCV incidence in an urban emergency department population.J Viral Hepat. 2018; 25: 1397-1400
- Moving beyond screening: how emergency departments can help extinguish the HIV/AIDS epidemic.West J Emerg Med. 2016; 17: 135-138
- Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings.MMWR Recomm Rep. 2006; 55 ([quiz CE1-4]): 1-17
- Routine HIV screening in two health-care settings—New York City and New Orleans, 2011-2013.MMWR Morb Mortal Wkly Rep. 2014; 63: 537-541
- Acute HIV infection and implications of fourth-generation HIV screening in emergency departments.Ann Emerg Med. 2014; 64: 547-551
- Vital signs: HIV diagnosis, care, and treatment among persons living with HIV—United States.MMWR Morb Mortal Wkly Rep. 2011; 63 (2014): 1113-1117
- The evolving landscape of HIV screening in the emergency department.Ann Emerg Med. 2018; 72: 54-56
- Hepatitis C virus screening: an important public health opportunity for United States emergency departments.Ann Emerg Med. 2016; 67: 129-130
- A novel emergency department based prevention intervention program for people living with HIV: evaluation of early experiences.BMC Health Serv Res. 2007; 7: 164
- R: A language and environment for statistical computing.R Foundation for Statistical Computing, V., Austria2017 (URL)
Article Info
Publication History
Published online: May 10, 2020
Accepted:
May 6,
2020
Received in revised form:
May 5,
2020
Received:
April 10,
2020
Identification
Copyright
© 2020 Published by Elsevier Inc.
