scholarly journals HIV testing in patients who are HCV positive: Compliance with CDC guidelines in a large healthcare system

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252412
Author(s):  
Ilan Fleisher ◽  
Alexander G. Geboy ◽  
Whitney Nichols ◽  
Sameer Desale ◽  
Stephen Fernandez ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Retrospective Chart Review ◽  
Clinical Decision ◽  
The United States ◽  
Hiv Positive ◽  
Provider Education ◽  
Support Tools ◽  
Testing Data ◽  
Cdc Guidelines ◽  
Multivariable Analyses

Background There are approximately 300,000 people in the United States who are co-infected with HIV and HCV. Several organizations recommend that individuals who are HCV infected, as well as persons over the age of 13, should be HIV tested. Comorbidities associated with HCV can be reduced with early identification of HIV. Our objective was to determine whether providers routinely followed HIV testing guidelines for patients who tested HCV positive (HCV+). Methods A retrospective chart review was conducted of all patients in primary care at an academic health system from 7/2015–3/2017 who tested HCV+. As part of a primary database, HCV testing data was collected; HIV testing data was abstracted manually. We collected and described the intervals between HCV and HIV tests. To determine associations with HIV testing univariable and multivariable analyses were performed. Results We identified 445 patients who tested HCV+: 56.6% were tested for HIV, the mean age was 57 ± 10.9 years, 77% were from the Birth Cohort born 1945–1965 (BC); 61% were male; and 51% were Black/AA. Patients in the BC were more likely to be HIV tested if they were: male (p = 0.019), Black/AA (p<0.001), and had Medicaid (p = 0.005). These differences were not found in the non-BC. Six patients who were tested for both HIV and HCV were found to be newly HIV positive at the time of testing. Conclusion As demonstrated, providers did not routinely follow CDC recommendations as almost half of the HCV+ patients were not correctly tested for HIV. It is important to emphasize that six persons were tested HIV positive simultaneously with their HCV+ diagnosis. If providers did not follow the CDC guidelines, then these patients may not have been identified. Improvements in EHR clinical decision support tools and provider education can help improve the HIV testing rate among individuals who are HCV+.

scholarly journals 1655. Extrapulmonary Tuberculosis in a Large Healthcare System

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S816-S816
Author(s):  
Travis Denmeade ◽  
William Smith ◽  
Banks Kooken ◽  
Michael Leonard
Keyword(s):  
Health System ◽  
Healthcare System ◽  
Extrapulmonary Tuberculosis ◽  
Retrospective Chart Review ◽  
The United States ◽  
Primary Objective ◽  
Hiv Positive ◽  
Hiv Status ◽  
Southeastern Us ◽  
Race Ethnicity

Abstract Background The US has seen a rise in the proportion of patients with extrapulmonary tuberculosis (TB) even though the yearly incidence of new TB cases has been in decline. The purpose of this study was to analyze incidence of extrapulmonary TB at Atrium Health, a large non-profit health system in the Southeastern US. Methods Retrospective chart review of 94 adult patients with culture confirmed extrapulmonary TB between 2008-2019. Individuals younger than 18 years were excluded from analysis. The primary objective was to examine incidence of extrapulmonary TB and compare it to that reported in the literature. Secondary objectives included determination of sites of extrapulmonary disease and associated patient characteristics including HIV status, race, ethnicity, and birthplace. Results 237 patients were identified as having confirmed TB infection from 2008-2019 in a retrospective analysis within the Atrium Health System. 94 (40%) were found to have extrapulmonary disease; 42 (45%) with concomitant pulmonary disease. The patients were 55% male, 40% African American, 21% Hispanic or Latino, and 51% US-born. Median age was 44 years (range 20-62). The most common sites of extrapulmonary TB were lymphatic (35%), pleural (24%), GI/Peritoneal (12%), CNS (10%), and Bone/Joint (10%). Lymphatic involvement was 40% cervical, 19% intrathoracic, and 16% axillary. 66% of skeletal disease was vertebral. Other sites included GU, pericardial, skin, and disseminated disease (5%). 37% were HIV positive, 18% with unknown HIV status as they were never tested. Information regarding patient’s race, ethnicity, and birthplace were unknown for 2 patients. The percentage of extrapulmonary cases were 29% in 2008, 39% in 2012, 38% in 2016, and 49% in 2019. Conclusion Lymphatic and pleural involvement were the most common extrapulmonary sites. Of those tested, 37% were HIV positive but there was a significant portion never tested showing a need for increased testing. The proportion of extrapulmonary TB cases since 2008 is higher at 40% compared to the 31% reported in the United States. There has been a rise in the proportion of extrapulmonary TB within our healthcare system and deserves further analysis. Disclosures All Authors: No reported disclosures

scholarly journals 1297. Examining the Successes and Challenges of Implementing HIV Testing Clinical Decision Support in the Emergency Department

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S467-S468
Author(s):  
Mariah Powell ◽  
Michael Gierlach ◽  
Sandra L Werner ◽  
David S Bar-Shain ◽  
Ann Avery
Keyword(s):  
Emergency Department ◽  
Decision Support ◽  
Hiv Testing ◽  
Clinical Decision Support ◽  
Screening Tool ◽  
Clinical Decision ◽  
The United States ◽  
Hiv Screening ◽  
Implementation Challenges ◽  
Start Date

Abstract Background In 2016, MetroHealth System (MHS) launched the FOCUS (Frontlines of Communities in the United States) project to routinize HIV testing in the emergency department (ED). Before 2016, clinical decision support (CDS) for HIV testing was not in place, nor was there a policy to support the importance of opt-out, nontargeted screening. The purpose of this study was to outline the progress of HIV testing after the integration of CDS, as well as describe the implementation challenges, and how certain events impacted HIV testing. Methods HIV testing data from MHS EDs were collected from October 1, 2015 to March 31, 2019 and graphed into a run chart. The dataset was mapped with the following events: project start date, ED testing begins (without CDS), CDS implementation, the staffing of the ED Testing Coordinator (EDTC), and optimization of CDS (Figure 1). To determine whether observed variation in the dataset is due to random or special cause variation, these run chart rules were applied: Run, Shift (Figure 2), and Trend. Results There were 42 data points and 4 runs. With 42 points, the lower limit of runs was 16 and the upper limit of runs was 28. This signals that one or more special cause variations were present. A total of three distinct shifts were observed indicating special cause variation. The run chart did not include any downward or upward trends. Testing increased as much as 3971% (7 tests in October 2015 vs. 285 tests in March 2018). Conclusion HIV testing increased from 7 tests to 86 tests (Shift 1). This coincided with establishment of an ED testing policy in April 2016. Testing increased to 266 tests in October 2016 (Shift 2). This directly related to implementation of CDS in the ED. December 2017 displayed the lowest testing with 117 tests. This was due to lack of policy awareness, and to the rarely-visited location of the HIV screening tool during the triage process. Staff was re-educated and the HIV screening tool was moved to a more visible location. This resulted in 227 tests in February 2018, and was followed by the highest testing month with 285 tests (Shift 3). Continued challenges prohibit sustained upward trends in ED testing. A control chart may be the appropriate next step to identify new control limits Disclosures All authors: No reported disclosures.

scholarly journals 954. Missed opportunities for HIV Screening in the Emergency Department

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S508-S509
Author(s):  
Amanda Hirsch ◽  
Christopher F Carpenter
Keyword(s):  
Hiv Testing ◽  
Transmission Rate ◽  
Retrospective Chart Review ◽  
The United States ◽  
Hiv Screening ◽  
Hiv Diagnosis ◽  
Missed Opportunities ◽  
Hiv Test ◽  
Diagnosis Rate

Abstract Background There are 1.14 million people infected with human immunodeficiency virus (HIV) in the United States, and only about 86% are diagnosed. HIV diagnosis is the first step to care and expanded testing is essential to reduce transmission. Individuals with undiagnosed HIV have a transmission rate 3.5 times higher than those aware of their infection. Individuals seeking testing and treatment for sexually transmitted infections (STIs) represent a higher risk population for HIV infection. Despite revised Centers for Disease Control and Prevention (CDC) recommendations to expand HIV testing in healthcare settings, testing remains low. A significant obstacle to expanded testing, especially in emergency departments (EDs), is concern about ensuring appropriate HIV test tracking and follow-up. Methods We performed a retrospective chart review of patients presenting with symptoms of an STI between January 1, 2015 and July 8, 2019 at eight Beaumont Health EDs in Southeast Michigan. De-identified data was collected from the electronic health record (EHR) for patients aged 10 and older who had testing for one or more STIs including gonorrhea, syphilis, and chlamydia. Patients were evaluated for concurrent HIV testing during the encounter, and patients known to be HIV infected were excluded. Results Of 32,640 encounters during which patients not known to be HIV infected were tested for STIs, only 68 (0.21%) included HIV antibody/antigen screening. Of those tested, only one (1.47%) returned reactive. The remaining 67 screenings returned non-reactive. Applying only 10% of this diagnosis rate to the total number of STI encounters suggests an opportunity to diagnose 47 additional individuals; applying 50% of this rate and the corresponding value is 239 individuals. Conclusion These results highlight the need for expanded HIV screening in EDs. Systematic HIV test tracking and follow-up removes this burden from ED providers and enables expanded HIV testing in these settings. Disclosures All Authors: No reported disclosures

Redefining and Improving Patient Safety

2002 ◽  
Vol 41 (04) ◽  
pp. 271-276 ◽  
Author(s):  
M. J. Ball ◽  
J. V. Douglas
Keyword(s):  
Patient Safety ◽  
Retrospective Chart Review ◽  
The United States ◽  
Professional Organizations ◽  
Institute Of Medicine ◽  
Governmental Agencies ◽  
Support Tools ◽  
Information And Communication ◽  
Computerized Monitoring ◽  
Physician Order Entry

Summary Objectives: The Institute of Medicine (IOM) has focused attention on patient safety in the united States. Other countries share these concerns. Methods: Governmental agencies and professional organizations are redefining approaches to safety, calling upon the use of information and communication technology as an enabler and expanding the range of evidence admissible in documenting success. Results: Efforts to understand medical errors have used retrospective chart review, incident reporting, and computerized surveillance; the result is an evolving picture of the number, nature, and cause of errors. Approaches used to prevent errors include computerized physician order entry, decision support tools, computerized monitoring, and evidence-based practice; varying levels of evidence document their success. Conclusions: Technology offers challenging capabilities, not simple solutions. New evidence and new tools demand new approaches and attention to human factors.

scholarly journals Making a Big Impact on Expanding HIV Inpatient Testing with a Small EHR Modification

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S426-S426
Author(s):  
Tri Nguyen
Keyword(s):  
Hiv Testing ◽  
Medical Center ◽  
Hiv Positive ◽  
Screening Methods ◽  
Inpatient Setting ◽  
Jersey City ◽  
Cdc Guidelines ◽  
Inpatient Settings ◽  
Living With Hiv ◽  
Number Of Individuals

Abstract Background The CDC estimates over 1.2 million Americans are living with HIV and, of those, approximately 14% are unaware of their HIV-positive status. Since 2014, most hospitals adopted some form of Electronic Health Records (EHR) and the Centers for Medicare & Medicaid Services extended Medicare coverage for annual HIV screenings. Despite these developments, there has been limited progress in expanding HIV testing in inpatient settings. The present study was conducted at Jersey City Medical Center (JCMC) in an effort to expand HIV testing by implementing EHR modification in the form of testing prompts. Methods This study began on January 1, 2016 at JCMC, a teaching hospital that passed all lab work orders through an EHR system. The number of daily orders for HIV screenings was recorded for 145 consecutive days before EHR modification (n = 145) to establish baseline data. EHR modification occurred on the 146th day of the study (May 25, 2016). This modification featured testing prompts displaying CDC guidelines for screening patients over the age of 18 for HIV whenever a physician ordered lab work for admitted patients. Orders for HIV screenings on this transitional date were excluded from analysis. After EHR modification was completed, the number of daily orders for HIV screenings was recorded for an additional 145 consecutive days (n = 145) for comparison. Testing data was available for all 145 consecutive days before and 145 consecutive days after EHR modification. Results Since the beginning of this study—before testing prompts were implemented—JCMC inpatient units ordered an average of 8.53 (SD=3.25) HIV screenings per day. The average number of daily orders for HIV screenings increased twofold after EHR modification (M=17.39, SD=4.26), t(288) = 19.90, P &lt; .001. JCMC identified 86 HIV-positive and linked over 90% of these patients to care. Conclusion Conventional HIV screening methods in the inpatient setting might not be sufficient at detecting most HIV-positive cases. By implementing testing prompts in its EHR system to encourage increased testing for HIV, Jersey City Medical Center was able to increase the number of individuals aware of their HIV status and link them to care as needed. Disclosures T. Nguyen, Gilead FOCUS: Employee, Grant recipient

Prior HIV testing behaviour is associated with HIV testing results among men, trans women and trans men who have sex with men in the United States

2020 ◽  
pp. jech-2019-213493
Author(s):  
Christian Grov ◽  
Drew Westmoreland ◽  
Sarit A Golub ◽  
Denis Nash
Keyword(s):  
Primary Care ◽  
Hiv Testing ◽  
The United States ◽  
Hiv Positive ◽  
Methamphetamine Use ◽  
Trans Men ◽  
Negative Results ◽  
Sex With Men ◽  
Positive Results ◽  
Hiv Negative

BackgroundAmong those at high risk for HIV, it is important to examine the ways in which someone who has recently tested for HIV might differ from someone who has not.MethodsIn 2017–2018, a total of 5001 men, trans women and trans men who have sex with men from across the United States completed an online survey about their recent testing behaviour as well as self-collected oral samples for HIV testing.ResultsIn total, 3.8% tested HIV-positive and—among those with positive results—35% were recent HIV infections (ie, self-reported an HIV-negative test result within the 12 months prior to enrollment). Those with HIV-positive results—regardless of how recent their HIV test was prior to enrollment—differed from those with negative results in ways that are known to be associated with HIV risk: racial and income disparities, housing instability, recent transactional sex and recent methamphetamine use. Among those with HIV-positive results at enrollment, only having a primary care physician distinguished those who recently tested negative prior to enrollment versus not. Among those with HIV-negative results, there were numerous differences between those who had recently tested for HIV prior to enrollment, versus not, such that those who had not recently tested were significantly more likely to report being at higher risk for HIV.ConclusionStrategies aimed at improving more frequent HIV testing among HIV-negative persons at high risk for HIV should address other needs including stable housing, transactional sex, access to a primary care provider and methamphetamine use.

Home HIV Testing and Conflicts with State HIV Testing Regulations

1995 ◽  
Vol 21 (4) ◽  
pp. 419-444
Author(s):  
William O. Fabbri
Keyword(s):  
Hiv Testing ◽  
The United States ◽  
Hiv Positive ◽  
State Governments ◽  
Test Results ◽  
Health Departments ◽  
Hiv Counseling ◽  
Public Health Departments ◽  
Hiv Test ◽  
Set Up

Currently the number of AIDS-related deaths in the United States has reached 311,000 and at least one million more Americans are infected with HIV. Of those one million or more infected, many spread the virus unknowingly as approximately forty percent of those infected have never been tested. More than eighty-five percent of the U.S. population has never been tested for HIV. No cure or vaccine for HIV currently exists.The federal and state governments have set up a patchwork of free and confidential HIV testing at local clinics. States have enacted a variety of legislation concerning HIV testing and test results. Most states have enacted statutes that require informed consent for an HIV test to be conducted. All states require the reporting of AIDS cases, and many also require the reporting of HIV-positive status to state public health departments. Furthermore, many states mandate certain requirements for HIV counseling.

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