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

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

scholarly journals The Prevalence of Undiagnosed HIV Infection in Those Who Decline HIV Screening in an Urban Emergency Department

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
M. Czarnogorski ◽  
J. Brown ◽  
V. Lee ◽  
J. Oben ◽  
I. Kuo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Hiv Screening ◽  
Opt Out ◽  
Undiagnosed Hiv ◽  
Routine Hiv Screening ◽  
The Difference ◽  
Routine Hiv Testing ◽  
Urban Emergency Department

Objective. To determine the prevalence of occult HIV infection in patients who decline routine HIV testing in an urban emergency department.Design, Setting, and Patients. Discarded blood samples were obtained from patients who had declined routine ED HIV testing. After insuring that the samples came from patients not known to be HIV positive, they were deidentified, and rapid HIV testing was preformed using 5 μL of whole blood.Main Outcome Measures. The prevalence of occult HIV infection in those who declined testing compared with prevalence in those who accepted testing.Results. 600 consecutive samples of patients who declined routine HIV screening were screened for HIV. Twelve (2%) were reactive. Over the same period of time, 4845 patients accepted routine HIV testing. Of these, 35 (0.7%) were reactive. The difference in the prevalence of HIV infection between those who declined and those who accepted testing was significant (). The relative risk of undetected HIV infection in the group that declined testing was 2.74 times higher (95% CI 1.44–5.18) compared with those accepted testing.Conclusion. The rate of occult HIV infection is nearly three-times higher in those who decline routine ED HIV testing compared with those who accept such testing. Interventions are urgently needed to decrease the opt-out rate in routine ED HIV testing settings.

scholarly journals 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

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S513-S514
Author(s):  
Swetha Kodali ◽  
Jeffrey M Paer ◽  
Alexander W Sudyn ◽  
Samuel Maldonado ◽  
Amesika Nyaku ◽  
...  
Keyword(s):  
Emergency Department ◽  
New Jersey ◽  
Linkage To Care ◽  
Safety Net ◽  
Patient Navigator ◽  
Hiv Screening ◽  
Newly Diagnosed ◽  
Heterosexual Contact ◽  
Opt Out ◽  
The Impact

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

Assessment of Nurse Perspectives on an Emergency Department-Based Routine Opt-Out HIV Screening Program

2017 ◽  
Vol 28 (3) ◽  
pp. 316-326 ◽  
Author(s):  
Sara Heinert ◽  
Julius Carter ◽  
Cammeo Mauntel-Medici ◽  
Janet Lin
Keyword(s):  
Emergency Department ◽  
Screening Program ◽  
Hiv Screening ◽  
Opt Out

scholarly journals Automated HIV screening in the emergency department –earlier diagnosis, improved clinical outcomes

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Vaz Pinto ◽  
M Guimaraes ◽  
V Castro ◽  
C Santos ◽  
A Galiano ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Screening Program ◽  
Public Health Problem ◽  
Undetectable Viral Load ◽  
Late Presentation ◽  
Screening Tests ◽  
Treatment As Prevention ◽  
Hiv Screening ◽  
Opt Out

Abstract Background HIV/AIDS is a public health problem worldwide because undiagnosed patients maintain onward transmission. To stop viral transmission an upscale in diagnostics is needed so that more patients start treatment; patients on treatment and with undetectable viral load do not transmit the virus to other persons (“Treatment as Prevention”). Objectives We aimed at identifying more HIV infections in the emergency Department (ED) and at doing so earlier in the course of disease. Methods we designed an automated and clinician independent HIV screening project in the ED. Electronic Medical Record (EMR) automatically generates a request for HIV antibody (HIV Ab) test when a patient: a) is 18-65 years of age and has a request for any blood test; b) is not identified in the EMR as being HIV infected; c) does not have an HIV Ab in the EMR in the previous year. Nursing staff receive a visual warning of patients' eligibility for screening and an extra tube label is printed out for HIV testing. The patient is informed of screening at the moment of blood drawing and an <<opt-out >> strategy is applied (optional verbal informed consent or <<opt-out >> of screening). Results In 16 months, a total of 21.487 people were eligible for screening. 18.072 HIV Ab screening tests were done. The opt-out rate was 6.3% and there were 44 new HIV diagnostics (prevalence rate 0.24%). Late presenting patients (baseline CD4 counts <350) dropped from an average of 56% in the previous 6 years at our institution to 36.3%. Median CD4 count at diagnostics went up from 192 to 388 cells/mm³. Conclusions An automated and clinician independent HIV screening program in the ED proved to be successful at identifying more HIV patients and at tackling the problem of late presentation. Diagnosing early in the course of infection is beneficial for the individual patient, but also represents a gain in general public health because onward transmission is stopped by starting antiretroviral treatment. Key messages Early diagnosis through universal screening. Treatment as prevention.

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

2015 ◽  
Vol 23 (2) ◽  
pp. 396-401 ◽  
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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