968. The Impact of Opt-Out HIV Screening and Patient Navigator-Assisted Linkage to Care of Newly Diagnosed Persons with HIV in a High-Prevalence Emergency Department

Abstract Background Newark is the epicenter of the HIV epidemic in New Jersey. University Hospital, the state’s only public safety net hospital, plays a critical role in identifying and linking newly diagnosed persons with HIV (PWH) to care. We previously showed that the emergency department (ED) is the most common setting for missed testing opportunities. Therefore, in 2015 we implemented a routine opt-out HIV screening and patient navigator (PN)-assisted linkage to care (LTC) protocol in the ED, and this project examined the LTC rates for newly diagnosed PWH. Methods We conducted an IRB-approved retrospective chart review of patients who tested positive for HIV in the ED between 2015 and 2018. Descriptive statistics were used to summarize demographic and clinical data. Univariate and multivariate regression were used to identify demographic and clinical factors associated with LTC for newly diagnosed PWH. Age, sex, and factors with p ≤ 0.10 in the univariate analysis were included in the final model. Results Of the 464 patients who screened positive, 123 (26.5%) were new diagnoses. The mean age was 41.0 years (SD = 13.8); 82 (67%) male; 74 (60%) black, 26 (21%) Hispanic, 7 (6%) white. The median CD4 count was 242 (IQR = 120 - 478) cells/µL, and 10 patients (8.1%) had acute HIV infection. Six patients (4.9%) died before LTC. Among the remaining 117 patients, PN outreach resulted in scheduled appointments at the Infectious Disease Practice for 102 (87.2%). In total, 79 (67.5%) were linked to care and 38 (32.5%) were referred to the state for linkage. Of the patients linked to care, 49 (62.0%) attended their first appointment and 30 (38.0%) required additional PN outreach. Men who have sex with men (MSM) (OR = 17.2, p = 0.002) and heterosexual contact (OR = 6.3, p < 0.001) were predictive of LTC. Conclusion Our protocol resulted in LTC for the majority of newly diagnosed PWH. Among those linked to care, over a third required additional PN outreach after missing their first appointment, highlighting the importance of PN follow-up. MSM and heterosexual contact, the two highest risk factors for HIV in New Jersey, were predictive of LTC. Their successful LTC may be explained, in part, by the fact that PNs were demographically similar and lessened perceived stigma associated with entry into care. Disclosures All Authors: No reported disclosures

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962. Linkage to Care Outcomes among Known HIV-Positive Patients at a High Prevalence Urban Hospital Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1148 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S511-S511

Author(s):

Alexander W Sudyn ◽

Jeffrey M Paer ◽

Swetha Kodali ◽

Samuel Maldonado ◽

Amesika Nyaku ◽

...

Keyword(s):

Hiv Risk ◽

Hiv Transmission ◽

Univariate Analysis ◽

Linkage To Care ◽

Retrospective Chart Review ◽

Retention In Care ◽

Patient Navigator ◽

Urban Hospital ◽

Opt Out ◽

The Impact

Abstract Background Retention in care of persons with HIV (PWH) is essential for achieving viral suppression and decreasing community transmission. CDC estimates that the 23% of known PWH not retained in care account for 43% of all new transmissions. This study seeks to describe the impact of an opt-out ED screening with navigator-assisted linkage to care (LTC) protocol for out of care PWH. Methods An IRB-approved retrospective chart review was conducted among PWH (prior positive) inadvertently retested in the ED between 2015 and 2018. Univariate and multivariate logistic regression was used to identify factors associated with LTC with patient navigator (PN) support. Factors with p ≤ 0.1 were included in the multivariate analysis as were age and sex at birth. Patients who died were excluded from statistical analyses. Results Among 464 patients who tested positive, 338 (73%) were known positive with 120 (35%) of those out of care at the time of screening. Mean age for this group was 47 (SD 11.9); 57% male, 81% non-Hispanic black, 10% Hispanic, and 6% non-Hispanic white. Fifty-five (46%) patients were successfully LTC, 54 (45%) referred to the state for linkage, and 11 (9%) died. A total of 109 patients were included in the analysis. Univariate analysis was performed for age (F(1, 107) = 0.98, p = 0.324) and female sex at birth (OR = 1.42 [95% CI 0.66, 3.05], p = 0.373) as well as Hispanic race (OR = 3.33 [95% CI 0.84, 13.04], p = 0.085), heterosexual HIV risk (OR = 2.76 [95% CI 1.27, 5.99], p = 0.011), IDU (OR = 0.49 [95% CI 0.21, 1.11], p = 0.088), and other SUD (OR = 0.42 [95% CI 0.19, 0.94], p = 0.035). Only heterosexual HIV risk (OR = 3.01 [95% CI 1.23, 7.32], p = 0.015) maintained significance in the final multivariate model. Conclusion Opt-out ED screening revealed >30% of known positive PWH were out of care at the time of testing; of whom nearly 50% were LTC with PN support. It is possible that persons reporting heterosexual HIV risk may feel less stigmatized and therefore are more likely to LTC. Similarly, the association with SUD, albeit non-significant, may reflect underrepresentation of individuals with SUD in remission among patient navigators. Future opt-out ED screening protocols should build upon diverse care teams to further engage patients with SUD and those at risk for non-heterosexual HIV transmission. Disclosures All Authors: No reported disclosures

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845. Impact of the COVID-19 Pandemic on Routine HIV Screening in an Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1040 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S513-S513

Author(s):

Elizabeth A Aguilera ◽

Gilhen Rodriguez ◽

Gabriela P Del Bianco ◽

Gloria Heresi ◽

James Murphy ◽

...

Keyword(s):

Emergency Department ◽

Screening Program ◽

Medical Center ◽

Hiv Infections ◽

Hiv Screening ◽

Opt Out ◽

Number Of Patients ◽

Confirmatory Tests ◽

Routine Hiv Screening ◽

The Impact

Abstract Background The Emergency Department (ED) at Memorial Hermann Hospital (MHH) - Texas Medical Center (TMC), Houston, Texas has a long established screening program targeted at detection of HIV infections. The impact of the COVID-19 pandemic on this screening program is unknown. Methods The Routine HIV screening program includes opt-out testing of all adults 18 years and older with Glasgow score > 9. HIV 4th generation Ag/Ab screening, with reflex to Gennius confirmatory tests are used. Pre-pandemic (March 2019 to February 2020) to Pandemic period (March 2020 to February 2021) intervals were compared. Results 72,929 patients visited MHH_ED during the pre-pandemic period and 57,128 in the pandemic period, a 22% decline. The number of patients tested for HIV pre-pandemic was 9433 and 6718 pandemic, a 29% decline. When the pandemic year was parsed into first and last 6 months interval and compared to similar intervals in the year pre pandemic, 39% followed by 16% declines in HIV testing were found. In total, 354 patients were HIV positives, 209, (59%) in the pre-pandemic and 145 (41%) in the pandemic period.The reduction in new HIV infections found was directly proportional to the decline in patients visiting the MHH-ED where the percent of patients HIV positive was constant across intervals (2.21% vs 2.26%). Demographic and outcome characteristics were constant across the compared intervals. Conclusion The COVID -19 pandemic reduced detection of new HIV infections by screening in direct proportion to the reduction in MHH-ED patient visits. The impact of COVID-19 pandemic decreased with duration of the pandemic. Disclosures All Authors: No reported disclosures

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Factors Associated With No or Delayed Linkage to Care in Newly Diagnosed Human Immunodeficiency Virus (HIV)-1-Infected Patients Identified by Emergency Department-based Rapid HIV Screening Programs in Two Urban EDs

Academic Emergency Medicine ◽

10.1111/j.1553-2712.2012.01351.x ◽

2012 ◽

Vol 19 (5) ◽

pp. 497-503 ◽

Cited By ~ 28

Author(s):

Richard E. Rothman ◽

Gabor D. Kelen ◽

Leah Harvey ◽

Judy B. Shahan ◽

Heather Hairston ◽

...

Keyword(s):

Emergency Department ◽

Human Immunodeficiency Virus ◽

Linkage To Care ◽

Hiv Screening ◽

Newly Diagnosed ◽

Screening Programs ◽

Factors Associated ◽

Immunodeficiency Virus ◽

Hiv 1

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1292. Integrating HIV and Hepatitis C Screening in a High-Risk Emergency Department Population

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1155 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S466-S466

Author(s):

Tasleem Chechi ◽

Nam Tran ◽

Allyson C Sage ◽

Sarah Waldman ◽

Larissa S May

Keyword(s):

Emergency Department ◽

Hepatitis C ◽

Universal Screening ◽

Safety Net ◽

The United States ◽

High Rate ◽

Molecular Testing ◽

Newly Diagnosed ◽

Opt Out ◽

Hcv Screening

Abstract Background With the acceleration of the hepatitis C (HCV) epidemic in the United States and the ongoing public health impact of undetected human immunodeficiency virus (HIV) co-infection, there is a critical need for enhanced secondary prevention efforts where patients accessing care are not routinely screened. The purpose of this program was to implement routine opt-out HIV and HCV screenings in a high-volume urban emergency department (ED) through the use of an EMR enhancement to increase a provider’s likelihood of testing eligible patients, and to provide linkage to care for patients identified to have positive tests. Methods From November 27, 2018 to March 31, 2019, EMR-based HIV and HCV screening was implemented in a quaternary care ED in Northern California. EMR best practice alerts were developed based on a combination of local and CDC guidelines and populated on registered patients receiving blood laboratories or receiving STI testing. Laboratory HIV/HCV screening utilized a unique two-specimen collection scheme to enable molecular testing without requiring patient return visits. Patients were excluded if they chose to opt out from testing or the provider deemed opt out was not possible. Upon notification of a positive test result through the EMR, a patient navigator was responsible for providing disease education and linking patients to care. Results The prevalence of HCV antibody positivity was 9.6% (637/6,627) and 0.97% (55/5,628) for HIV. Of the 255 HCV-RNA positives, 110 were known and 145 newly diagnosed. Of the 90 HIV patients, 31 were known and 8 newly diagnosed. Although current CDC hepatitis C screening guidelines recommend screening all adults born during 1945–1965, we conducted universal screening of adults 18 years or older. Of those screened antibody-positive for HCV 64% fell within the 1945–1965 birth cohort. Conclusion Introducing routine opt-out testing using an automated EMR-based screening program is an effective method to identify and screen eligible patients for HIV and HCV in episodic care safety net settings where universal screenings are not routinely implemented. The unexpectedly high rate of HIV seroprevalence suggests the ED environment continues to be an important setting to access populations not receiving routine care despite longstanding CDC recommendations for universal screening. Disclosures All authors: No reported disclosures.

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1273. Routine Opt-out HIV Screening and Detection of HIV Infection Among Emergency Department Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1106 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S388-S388

Author(s):

Nada Fadul ◽

Ciarra Dortche ◽

Richard Baltaro ◽

Tim Reeder

Keyword(s):

Emergency Department ◽

Hiv Infection ◽

Hiv Testing ◽

Medical Center ◽

Linkage To Care ◽

Hiv Care ◽

Hiv Positive ◽

Newly Diagnosed ◽

Opt Out ◽

Post Test

Abstract Background The Southeastern United States bears a disproportionate burden of HIV infection, accounting for nearly half of all new cases. The Centers for Disease Control and Prevention released routine opt-out testing recommendations in 2006. Our emergency department collaborated with our infectious diseases clinic (ECU-ID) to implement suggested guidelines among adults since March 2017. Methods Our primary aim was to implement routine, opt-out HIV testing in the Vidant Medical Center Emergency Department (ED) for patients between 18 and 65 years of age who have blood work completed, and have not had a test documented in the electronic medical record (EMR) in the last year. A secondary aim was to successfully link HIV-positive patients to care at ECU-ID or preferred clinic. Methods defining programmatic success included developing nurse directed opt-out ordering protocol, integrating testing into normal ED workflow, utilizing the existing EMR to prompt testing, and hiring a linkage coordinator to initiate post-test counseling and linkage-to-care. Results Since March 2, 2017, a total of 7,109 HIV tests were performed; an average of 592 monthly tests conducted compared with a previous average of 10 stat tests. Testing increased 5,820% compared with 2015. Of the 21 HIV-positive patients found, 16 were newly diagnosed. Among those newly diagnosed, 14 (87.5%) were linked to care; and among the five known positives, two (40%) were linked to care. Reasons why patients could not be linked included incarceration, refusal to link to care, and re-location. Conclusion Joined with the implementation of a routinized ED HIV testing program, a seamless process was developed to link persons found to be positive in the ED to HIV care services; therefore, establishing a systems-level prevention model. Future plans include expanding testing to adolescents and utilizing similar methods to integrate Hepatitis C testing. Disclosures All Authors. Gilead Sciences, Inc.: Grant Investigator, Grant recipient and Salary.

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Evolution and Escalation of an Emergency Department Routine, Opt-out HIV Screening and Linkage-to-Care Program

Public Health Reports ◽

10.1177/00333549161310s112 ◽

2016 ◽

Vol 131 (1_suppl) ◽

pp. 96-106 ◽

Cited By ~ 17

Author(s):

James W. Galbraith ◽

James H. Willig ◽

Joel B. Rodgers ◽

John P. Donnelly ◽

Andrew O. Westfall ◽

...

Keyword(s):

Emergency Department ◽

Linkage To Care ◽

Care Program ◽

Hiv Screening ◽

Opt Out

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Using a configurable EMR and decision support tools to promote process integration for routine HIV screening in the emergency department

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocv031 ◽

2015 ◽

Vol 23 (2) ◽

pp. 396-401 ◽

Cited By ~ 10

Author(s):

Robert McGuire ◽

Eric Moore

Keyword(s):

Emergency Department ◽

Decision Support ◽

Hiv Testing ◽

Screening Program ◽

Safety Net ◽

Hiv Screening ◽

Decision Support Tools ◽

Opt Out ◽

Safety Net Hospital ◽

Support Tools

Abstract Given the clinical and public health benefits of routine Human Immunodeficiency Virus (HIV) testing in the emergency department (ED) and Centers for Disease Control and Prevention recommendations, Maricopa Medical Center, as part of Maricopa Integrated Health System, started Test, Educate, Support, and Treat Arizona (TESTAZ) and became the first and, to-date, only hospital in Arizona to implement routine, non-targeted, opt-out, rapid HIV screening in the ED. The authors describe the implementation of a universal, routine, opt-out HIV screening program in the adult ED of an urban safety-net hospital serving under-served populations, including the uninsured and under-insured. Through a controlled and collaborative process, the authors integrated custom documentation elements specific to HIV screening into the triage/intake process, implemented and utilized clinical decision support tools to guide clinicians in each step of the process, and used electronic data collection and reporting to drive new screening protocols that led to a significant increase in overall HIV testing rates.

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Routine HIV Screening in Cancer Patients in the Emergency Department

Acute Medicine Journal ◽

10.52964/amja.0705 ◽

2018 ◽

Vol 17 (2) ◽

pp. 91-95

Author(s):

Terry W Rice ◽

◽

Patricia A. Brock ◽

Carmen Gonzalez ◽

Kelly W Merriman ◽

...

Keyword(s):

Emergency Department ◽

Hiv Testing ◽

Cancer Patients ◽

Linkage To Care ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Hiv Screening ◽

Immunodeficiency Virus ◽

Routine Hiv Screening ◽

Incident Cases

Treatment of human immunodeficiency virus(HIV) in cancer patients improves outcomes and reduces transmission of this oncogenic virus. HIV testing rates of cancer patients are similar to the general population (15-40%), despite the association with cancer. Our aim was to increase HIV screening in the Emergency Department(ED) of a comprehensive cancer center through a quality initiative. Testing increased significantly during the intervention (p<0.001; 0.15/day to 2.69/day). Seropositive HIV rate was 1.4% (12/852), with incidence of 0.3%. All patients were linked to care. Incident cases were between 36 and 55 years of age. Barriers encountered included confusion regarding the need for written consent for HIV testing, failure to consider ordering the test, and concerns regarding linkage to care.

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Opt-out screening for HIV, hepatitis B and hepatitis C: observational study of screening acceptance, yield and treatment outcomes

Emergency Medicine Journal ◽

10.1136/emermed-2019-208637 ◽

2019 ◽

Vol 37 (2) ◽

pp. 102-105 ◽

Cited By ~ 1

Author(s):

Conor Grant ◽

Sarah O'Connell ◽

Darren Lillis ◽

Anne Moriarty ◽

Ian Fitzgerald ◽

...

Keyword(s):

Hepatitis C ◽

Hepatitis B ◽

Screening Programme ◽

Linkage To Care ◽

Opt Out ◽

B Virus ◽

Lost To Follow Up ◽

The Impact ◽

Test Result

BackgroundWe initiated an emergency department (ED) opt-out screening programme for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) at our hospital in Dublin, Ireland. The objective of this study was to determine screening acceptance, yield and the impact on follow-up care.MethodsFrom July 2015 through June 2018, ED patients who underwent phlebotomy and could consent to testing were tested for HIV, HBV and HCV using an opt-out approach. We examined acceptance of screening, linkage to care, treatment and viral suppression using screening programme data and electronic health records. The duration of follow-up ranged from 1 to 36 months.ResultsOver the 36-month study period, there were 140 550 ED patient visits, of whom 88 854 (63.2%, 95% CI 63.0% to 63.5%) underwent phlebotomy and 54 817 (61.7%, 95% CI 61.4% to 62.0%) accepted screening for HIV, HBV and HCV, representing 41 535 individual patients. 2202 of these patients had a positive test result. Of these, 267 (12.1%, 95% CI 10.8% to 13.6%) were newly diagnosed with an infection and 1762 (80.0%, 95% CI 78.3% to 81.7%) had known diagnoses. There were 38 new HIV, 47 new HBV and 182 new HCV diagnoses. 81.5% (95% CI 74.9% to 87.0%) of known patients who were not linked were relinked to care after screening. Of the new diagnoses, 86.2% (95% CI 80.4 to 90.8%) were linked to care.ConclusionAlthough high proportions of patients had known diagnoses, our programme was able to identify many new infected patients and link them to care, as well as relink patients with known diagnoses who had been lost to follow-up.

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