scholarly journals 1274. Universal HIV and HCV Screening in San Diego Emergency Departments: Implications for Other Settings With a High Density of Free of Charge HIV Screening Programs

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S388-S388
Author(s):  
Martin Hoenigl ◽  
Chris Coyne ◽  
Jill Blumenthal ◽  
Gary Vilke ◽  
Susan Little
Keyword(s):  
Birth Cohort ◽  
San Diego ◽  
High Density ◽  
Hiv Screening ◽  
Newly Diagnosed ◽  
Screening Programs ◽  
Opt Out ◽  
Hiv Test ◽  
Hcv Screening ◽  
Hcv Testing

Abstract Background While HIV and HCV testing targeted to high-risk groups results in substantially higher proportions of HIV diagnoses, universal HIV and HCV screening in emergency department (ED) settings is expected to reach populations who do not perceive themselves to be at risk or are otherwise less likely to participate in HIV and HCV testing. As a consequence the CDC recommends routine HIV screening for persons 13–64 years of age, and routine HCV screening for the birth cohort (born between 1945–1965). The objective of this analysis was to evaluate the yield of universal opt-out HIV and HCV screening in the two EDs at the University of California San Diego (UCSD). Methods In July 2017, electronic medical record (EMR) based universal opt-out HIV screening (Architect HIV antibody [Ab]/HIV p24 antigen detection) for persons aged 13–64 years (excluding persons known HIV+ or reporteing an HIV test within the last 12 months) was implemented in our EDs. The EMR algorithm also identified HIV+ individuals who had been out of care for >12 months. In March 2018, EMR based universal HCV screening for birth cohort was added in both EDs. Results Over a period of 9 months 7,303 HIV tests were conducted, resulting in 24 (0.3%) new HIV diagnoses, of which 21 were successfully linked to care. In five individuals without HIV infection Architect gave a false-positive result (specificity 99.93%). In addition, the EMR algorithm identified 38 out of care HIV+ individuals of which 21 were successfully relinked to care. During the 1-month HCV birth cohort screening 963 HCV Ab tests were conducted, of which 106 (11%) resulted positive. At the time being 78 of those seropositive individuals had HCV RNA testing, of which 36 (53%) resulted positive (3.7% of all participants). Conclusion In San Diego, a setting with a high density of free-of charge HIV screening programs, 1/300 HIV tests in the ED yielded a new HIV diagnosis and in total 21 newly diagnosed individuals were linked to care. Identification of HIV+ out of care individuals yielded in an equivalent number of individuals relinked to care. The rate of newly diagnosed HCV infections exceeded the rate of newly diagnosed HIV infections by >10-fold outlining the importance of screening for HCV in the ED. Disclosures All authors: No reported disclosures.

scholarly journals Universal HIV and Birth Cohort HCV Screening in San Diego Emergency Departments

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Martin Hoenigl ◽  
Kushagra Mathur ◽  
Jill Blumenthal ◽  
Jesse Brennan ◽  
Miriam Zuazo ◽  
...  
Keyword(s):  
Emergency Departments ◽  
San Diego ◽  
Hiv Infections ◽  
Hcv Rna ◽  
Newly Diagnosed ◽  
Opt Out ◽  
Hiv Antigen ◽  
Hcv Antibody ◽  
Hcv Screening ◽  
Antigen Antibody

Abstract Universal HIV and HCV screening in emergency departments (ED) can reach populations who are less likely to get tested otherwise. The objective of this analysis was to evaluate universal opt-out HIV and HCV screening in two EDs in San Diego. HIV screening for persons aged 13–64 years (excluding persons known to be HIV+ or reporting HIV testing within last 12 months) was implemented using a 4th generation HIV antigen/antibody assay; HCV screening was offered to persons born between 1945 and 1965. Over a period of 16 months, 12,575 individuals were tested for HIV, resulting in 33 (0.26%) new HIV diagnoses, of whom 30 (90%) were successfully linked to care. Universal screening also identified 74 out-of-care for >12-months HIV+ individuals of whom 50 (68%) were successfully relinked to care. Over a one-month period, HCV antibody tests were conducted in 905 individuals with a seropositivity rate of 9.9% (90/905); 61 seropositives who were newly identified or never treated for HCV had HCV RNA testing, of which 31 (51%) resulted positive (3.4% of all participants, including 18 newly identified RNA positives representing 2% of all participants), and 13/31 individuals (42%) were linked to care. The rate of newly diagnosed HCV infections exceeded the rate of newly diagnosed HIV infections by >7-fold, underlining the importance of HCV screening in EDs.

scholarly journals Acceptance of Opt-Out HIV Screening in Outpatient Settings in the United States: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 134 (5) ◽  
pp. 484-492 ◽  
Author(s):  
Merhawi T. Gebrezgi ◽  
Daniel E. Mauck ◽  
Diana M. Sheehan ◽  
Kristopher P. Fennie ◽  
Elena Cyrus ◽  
...  
Keyword(s):  
United States ◽  
Systematic Review ◽  
Hiv Testing ◽  
Meta Analysis ◽  
The United States ◽  
Hiv Screening ◽  
Screening Programs ◽  
Opt Out ◽  
Hiv Test ◽  
Outpatient Settings

Objectives: In the United States, about 15% of persons living with HIV infection do not know they are infected. Opt-out HIV screening aims to normalize HIV testing by performing an HIV test during routine medical care unless the patient declines. The primary objective of this systematic review and meta-analysis was to assess the acceptance of opt-out HIV screening in outpatient settings in the United States. Methods: We searched in PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for studies published from January 1, 2006, through December 31, 2018, of opt-out HIV screening in outpatient settings. We collected data from selected studies and calculated for each study (1) the percentage of persons who were offered HIV testing, (2) the percentage of persons who accepted the test, and (3) the percentage of new HIV diagnoses among persons tested. We also collected information on the reasons given by patients for opting out. The meta-analysis used a random-effects model to estimate the average percentages of HIV testing offered, HIV testing accepted, and new HIV diagnoses. Results: We initially identified 6986 studies; the final analysis comprised 14 studies. Among the 8 studies that reported the size of the study population eligible for HIV screening, 71.4% (95% confidence interval [CI], 53.9%-89.0%) of the population was offered an HIV test on an opt-out basis. The test was accepted by 58.7% (95% CI, 47.2%-70.2%) of persons offered the test. Among 9 studies that reported data on new HIV diagnoses, 0.18% (95% CI, 0.08%-0.26%) of the persons tested had a new HIV diagnosis. Patients’ most frequently cited reasons for refusal of HIV screening were that they perceived a low risk of having HIV or had previously been tested. Conclusions: The rates of offering and accepting an HIV test on an opt-out basis could be improved by addressing health system and patient-related factors. Setting a working target for these rates would be useful for measuring the success of opt-out HIV screening programs.

scholarly journals 964. Opt-Out HIV- Hepatitis C (HCV) Testing at a Primary Care Resident Clinic in Columbia, SC: Who Gets Tested and Who Opts Out of Testing?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S512-S512
Author(s):  
Jodian Pinkney ◽  
Divya Ahuja ◽  
Caroline Derrick ◽  
Martin Durkin
Keyword(s):  
Primary Care ◽  
Hiv Testing ◽  
Demographic Variables ◽  
Demographic Characteristics ◽  
Categorical Variables ◽  
Newly Diagnosed ◽  
Opting Out ◽  
Opt Out ◽  
Primary Care Resident ◽  
Hcv Testing

Abstract Background South Carolina (SC) remains one of the most heavily affected states for both HIV and HCV infections. Males account for the majority of cases. Implementation of universal opt-out testing has improved screening rates but not much has been published describing the characteristics of those who opt out of testing. This becomes important as 10-50% of patients have opted out in previous studies. Methods Between February and August 2019, we conducted a quality improvement (QI) project which implemented opt- out HIV-HCV testing at a single primary care resident clinic in SC with the primary aim of increasing screening rates for HIV-HCV by 50%. Secondary aims included describing the demographic characteristics of the opt-out population. Persons were considered eligible for testing if they were between the ages of 18-65 years for HIV and 18-74 years for HCV. This was prior to the USPSTF 2020 guidelines which recommend HCV screening for adults aged 18-79 years. A retrospective chart review was used to obtain screening rates, opt status and demographic data. Logistic regression and the firth model were used to determine linkages between categorical variables. We present 3-month data. Results 1253 patients were seen between May 1, 2019- July 31, 2019 (See Table 1). 985 (78%) were eligible for HIV testing. 482 (49%) were tested for HIV as a result of our QI project and all tests were negative. 212 (22%) of eligible patients opted out of HIV testing. Males were 1.59 times more likely to opt out (p=0.008). (see Table 2,3) Regarding HCV, 1136 (90.7%) were deemed eligible for testing. 503 (44%) were tested for HCV as a result of our QI project. 12 (2.4%) were HCV antibody positive with viremia. 11 (90%) of antibody positive with viremia cases were in the 1945-1965 birth cohort (see Table 4). 244 (21%) opted out of HCV testing. Males and persons without a genitourinary chief complaint were more likely to opt out (p=0.02). Table 1: Demographic characteristics of the population seen at the internal medicine resident clinic between May- July 2019 Table 2: Relationship between demographic variables and the odds of being tested for HIV or HCV within the last 12 months. Logistic Model. Table 3: Relationship between demographic variables and the odds of opting out of testing for HIV or HCV. Firth Model. Conclusion Although implementation of routine HIV-HCV opt-out testing led to increased screening rates for both HIV and HCV, roughly 1 in 5 eligible patients chose to opt out of testing. Males were more likely to opt out despite accounting for the majority of newly diagnosed HCV cases. Future studies investigating drivers for opting-out in the male population could improve testing and assist with early diagnosis. Table 4: Characteristics of patients newly diagnosed with HCV positive with viremia. Disclosures All Authors: No reported disclosures

scholarly journals 291. Using Individualized Provider Feedback to Improve HCV Screening in a High-Volume Emergency Department

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S158-S158
Author(s):  
Jason Zucker ◽  
Fereshteh Sani ◽  
Kenneth Ruperto ◽  
Jacek Slowkowski ◽  
Lawrence Purpura ◽  
...  
Keyword(s):  
New York ◽  
Program Implementation ◽  
Text Message ◽  
High Volume ◽  
Outpatient Setting ◽  
Emergency Rooms ◽  
Screening Programs ◽  
Effective Program ◽  
Hcv Screening ◽  
Hcv Testing

Abstract Background Ending the Hepatitis C Virus (HCV) epidemic requires HCV testing as the critical first step. Busy urban Emergency Rooms are uniquely suited for HCV screening programs but numerous barriers to effective program implementation exist. We describe an emergency room physician champion model that utilizes the feedback intervention theory (FIT) to providers to increase HCV screening rates. Methods Due to the changing epidemiology of HCV in 2017 New York Presbyterian supported one-time universal HCV screening. In September 2018, our physician champion provided an educational session to ED providers about the importance of HCV screening and the proposed study. From the end of September to the end of March 2019, providers received a monthly e-mail from the ED champion and an automated text message with their individual and peer HCV screening rates. The number of HCV tests and percent of individuals with documented HCV testing in the ED was compared pre and post this intervention and to HCV testing in the inpatient and outpatient setting where feedback was not provided. Results On average ED providers evaluated approximately 14,000 patients per month. HCV testing increased 1,600% from an average of 40 tests per month in the 18 months prior to the intervention to an average of 640 tests sent per month during the intervention. tests sent in December. This was compared with stable inpatient and outpatient HCV screening during the same time period. Conclusion Individualized provider feedback paired with an ED physician champion can lead to a significant increase in HCV testing. Ongoing studies will determine if this intervention can lead to long-term behavior change. Disclosures All authors: No reported disclosures.

scholarly journals The Changing Demographics of Women Living with HIV/AIDS in Southern Alberta from 1982 to 2006

2012 ◽  
Vol 23 (2) ◽  
pp. e36-e40
Author(s):  
Liana Hwang ◽  
Jesse Raffa ◽  
Michael John Gill
Keyword(s):  
Hiv Testing ◽  
Hiv Infections ◽  
Hiv Care ◽  
Screening Methods ◽  
Newly Diagnosed ◽  
Female Population ◽  
Opt Out ◽  
Hiv Test ◽  
Southern Alberta ◽  
The Impact

INTRODUCTION: Women account for a growing proportion of HIV infections in Canada. This has implications with respect to prevention, diagnosis and treatment.OBJECTIVE: To describe the female population presenting for HIV care in southern Alberta and to examine the impact of opt-out pregnancy screening.METHODS: A retrospective review of demographic and clinical characteristics of all patients presenting to the Southern Alberta HIV Clinic (SAC) care program from 1982 to 2006, was performed.RESULTS: The proportion of newly diagnosed patients who were female increased from 7.5% before 1998 to 21.5% after 1998. Women were more likely to be from vulnerable populations, such as intravenous drug users (31.3% versus 13.7%, P<0.001), aboriginals/Métis (21.5% versus 8.7%, P<0.001), blacks (28.9% versus 4.9%, P<0.001) and immigrants (36.6% versus 14.7%, P<0.001). Heterosexual intercourse was the main risk factor for HIV acquisition (43.7%). Women were less likely than men to have requested HIV testing (20.9% versus 37.8%, P<0.001). Opt-out pregnancy screening accounted for 12.7% of HIV-positive tests in women, following its introduction in 1998. Of the women diagnosed by pregnancy screening, 62.1% were from HIV-endemic countries. There was an association between reason for testing and CD4 count at presentation; women who requested their HIV test had higher median CD4 counts than those diagnosed because of illness (478 cells/mL, interquartile range [IQR]=370 cells/mL versus 174 cells/mL, IQR=328 cells/mL, P<0.001) or pregnancy screening (478 cells/mL, IQR=370 cells/mL versus 271 cells/mL, IQR=256 cells/mL, P=0.001).CONCLUSIONS: Women were less likely than men to have requested HIV testing and were more likely to be diagnosed by population-based screening methods. Women, especially vulnerable groups, account for a growing number and proportion of newly diagnosed HIV infections in Alberta. The implications of expanded screening in this population merit further consideration.

Does the Centers for Disease Control and Prevention’s Recommendation of Opt-Out HIV Screening Impact the Effect of Stigma on HIV Test Acceptance?

2015 ◽  
Vol 20 (1) ◽  
pp. 107-114 ◽  
Author(s):  
Anish P. Mahajan ◽  
Janni J. Kinsler ◽  
William E. Cunningham ◽  
Saloniki James ◽  
Lakshmi Makam ◽  
...  
Keyword(s):  
Disease Control ◽  
Hiv Screening ◽  
Opt Out ◽  
Hiv Test ◽  
Centers For Disease Control

scholarly journals LO44: Birth cohort hepatitis C screening in an academic emergency department in Canada: preliminary results

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S23-S23
Author(s):  
S. Friedman ◽  
C. Capraru ◽  
K. Bates ◽  
D. Porplycia ◽  
T. Mazzulli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis C ◽  
Birth Cohort ◽  
Screening Program ◽  
Hcv Rna ◽  
Screening Programs ◽  
Hcv Prevalence ◽  
Canadian Association ◽  
The Us ◽  
Hcv Screening

Introduction: Epidemiologic and modeling studies suggest that between 45 and 70% of individuals with chronic hepatitis C virus (HCV) infection in Canada remain undiagnosed. The Canadian Association for the Study of the Liver (CASL) recommends one-time screening of baby boomers (1945-1975). Screening programs in the US have shown a very high prevalence of previously undiagnosed HCV among patients seen in the emergency department (ED). We sought to assess the feasibility of implementing a targeted birth-cohort HCV screening program in a Canadian ED setting. Methods: Patients born from 1945 to 1975 presenting to the ED of a downtown Toronto hospital were offered HCV testing. Patients with life-threatening conditions, unable to provide verbal consent in English or intoxication were excluded. Blood samples were collected by finger prick on Dried Blood Spot (DBS) collection cards and tested for anti-HCV antibody with reflex to HCV RNA. Patients with positive HCV RNA were referred to a liver specialist. Results: During a 27-month period (July 2017 - Sept 2019), 8363 patients in the birth cohort presented to the ED during daytime hours. 80% (6714) met eligibility criteria, and 48.4% (3247) were offered testing. Screening was performed by non-medical staff (mean 8/day, median spots on DBS 4). 345 (10.6%) had been previously tested, and 639 (19.7%) declined. 2136 (65.8%) patients underwent testing: median age 58.4 years (40-82), 1117 male (52.3%). Of these, 45 patients (2.1%; 95% CI 1.5%-2.7%) were anti-HCV positive: 32 (76.2%) were HCV RNA positive, 10 (23.8%) negative and 3 not done due to inadequate DBS sample. 26 patients (81.3%) were linked to care and 3 (9.4%) lost to follow-up. HCV prevalence in the ED was significantly higher than the general Canadian population (2.1% vs 0.7%; p < 0.0001) but much lower than reported rates in American EDs (2.1% vs 10.3%; p < 0.0001). Conclusion: Acceptance of HCV screening in the ED birth cohort was high and easily performed using DBS to ensure the majority of positive samples were tested for HCV RNA. Challenges included implementation that limited number of people tested, and linkage to care for HCV positive patients. HCV prevalence among this ED birth cohort was higher than the general population but lower than seen in the ED in the US. This may in part be due to exclusion of individuals with more severe medical issues, refusal by higher risk subgroups, or population and healthcare system differences between countries.

scholarly journals 904. Improving Infectious Disease Screening and Hepatitis C Care Cascade Outcomes Among Adults Receiving Medication Assisted Treatment

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S543-S544
Author(s):  
Sarah Hoehnen ◽  
Audra B Blood ◽  
Rachel Austermiller
Keyword(s):  
Treatment Outcomes ◽  
People Who Inject Drugs ◽  
Published Data ◽  
Hiv Screening ◽  
Hcv Treatment ◽  
Medication Assisted Treatment ◽  
Care Cascade ◽  
Opt Out ◽  
Hcv Screening ◽  
One Year

Abstract Background This initiative increased infectious disease (ID) screening in an adult medication assisted treatment (MAT) population at a Federally Qualified Health Center (FQHC) by implementing opt-out screening for HIV, viral hepatitis, and sexually transmitted infections (STIs), and assessed the success of a co-located hepatitis C (HCV) treatment program. Methods ID providers maintained a standing lab order for HIV, hepatitis A, hepatitis B, HCV, syphilis, chlamydia/gonorrhea (GC/CT), and trichomoniasis (trich), with reflex to confirmatory for HIV/HCV/syphilis. For all existing and new adult MAT patients, a MAT RN provided education, ensured lab draw on the day of MAT induction, and scheduled an ID follow-up visit. The patient then had an in-person or telemedicine visit with the ID provider to review results, discuss risk reduction, and initiate treatment (HIV PrEP or treatment for STI, HCV, or HIV) as indicated. Data was compiled and monitored by a Prevention RN. Plan, Do, Study, Act (PDSA) Model PDSA model demonstrating implementation approach Results The rate of testing among MAT patients increased over a one-year period. HCV treatment uptake in this setting exceeded that documented in published data for people who inject drugs (PWID). HCV Care Cascade Outcomes HCV screening and treatment outcomes within HCV Care Cascade model Screening Outcomes Screening rates among adult MAT population over a one-year measurement period Conclusion This study documents the successful implementation of an opt-out screening program among an adult substance use disorder (SUD) treatment population across urban, mixed, and designated rural environments. HCV treatment uptake in this setting exceeded that documented in published data for people who inject drugs (PWID). Barriers to implementation included acceptance among patients with long-term MAT participation, acceptance/adoption by behavioral health nursing and provider staff, and functional workflow development – establishment of protocol, lab availability, scheduling, and “tough sticks.” Modifications that increased effectiveness included an interdisciplinary approach and dedicated staff for monitoring results completion and patient outreach. Run chart: HIV screening rates over a one-year period HIV screening change among adult MAT patients over a one-year period Run chart: HCV screening rates over a one-year period HCV screening change among adult MAT patients over a one-year period HCV Care Cascade: HCV screening and treatment outcomes HCV screening and treatment outcomes presented in HCV Care Cascade for adult MAT population Disclosures All Authors: No reported disclosures

scholarly journals Hepatitis C screening in commercially insured U.S. birth-cohort patients: Factors associated with testing and effect of an EMR-based screening alert

2018 ◽  
Vol 6 (2) ◽  
pp. 82-89 ◽  
Author(s):  
Amoah Yeboah-Korang ◽  
Mohammad I. Beig ◽  
Mohammad Q. Khan ◽  
Jay L. Goldstein ◽  
Don M. Macapinlac ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatitis C ◽  
Birth Cohort ◽  
Best Practice ◽  
Sampling Period ◽  
Chronic Hemodialysis ◽  
Factors Associated ◽  
Hcv Screening ◽  
Best Practice Alert ◽  
Hcv Testing

Abstract Background and Objectives Hepatitis C virus (HCV) testing rates among U.S. birth-cohort patients have been studied extensively, limited data exists to differentiate birth-cohort screening from risk- or liver disease-based testing. This study aims to identify factors associated with HCV antibody (HCV-Ab) testing in a group of insured birth cohort patients, to determine true birth cohort testing rates, and to determine whether an electronic medical record (EMR)-driven Best Practice Alert (BPA) would improve birth cohort testing rates. Methods All birth-cohort outpatients between 2010 and 2015 were identified. HCV-Ab test results, clinical, and demographic variables were extracted from the EMR, and factors associated with testing were analyzed by logistic regression. True birth-cohort HCV screening rates were determined by detailed chart review for all outpatient visits during one calendar month. An automated Best Practice Alert was used to identify unscreened patients at the point of care, and to prompt HCV testing. Screening rates before and after system-wide implementation of the BPA were compared. Results The historic HCV-Ab testing rate was 11.2% (11,976/106,753). Younger age, female gender, and African American, Asian, or Hispanic ethnicity, and medical comorbidities such as chronic hemodialysis, HIV infection, and rheumatologic and psychiatric comorbidities were associated with higher testing rates. However, during the one-month sampling period, true age cohort-based testing was performed in only 69/10,089 patients (0.68%). Following the system-wide implementation of the HCV BPA, testing rates increased from 0.68% to 10.76% (P<0.0001). Conclusions We documented low HCV-Ab testing rates in our baby boomers population. HCV testing was typically performed in the presence of known risk factors or established liver disease. The implementation of an EMR-based HCV BPA resulted in a marked increase in testing rates. Our study highlights current HCV screening gaps, and the utility of the EMR to improve screening rates and population health.

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