Informing California's Plan to Enhance HIV Screening in the Ending the HIV Epidemic Initiative

The CDC recommends that everyone have at least one HIV test in their lifetime. However, analyses of California Health Interview Survey data showed that in 2017 only half of Californians had ever received an HIV test. Non-Hispanic Black (64.8%) and Hispanic adults (54.7%) had higher lifetime testing rates than non-Hispanic White adults (48.8%). In multivariable analyses non-Hispanic African American adults had twice and Hispanic adults 1.2 times the odds of lifetime HIV testing as non-Hispanic White adults. The CDC recommends annual HIV testing for higher-risk individuals. Independent of race/ethnicity, heterosexual men with multiple sex partners had lower annual testing rates than other high-risk individuals. Annual testing was unrelated to education level and poverty, but was related to number of doctor visits. HIV screening rates among heterosexual men with multiple partners could be increased by targeting HIV screening to non-medical settings in California's eight Ending the HIV Epidemic counties.

Download Full-text

1120. Impact of Training Residents to Improve HIV Screening in a Teaching Hospital in Mexico City

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1306 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S590-S590

Author(s):

Lorena Guerrero-Torres ◽

Isaac Núñez-Saavedra ◽

Yanink Caro-Vega ◽

Brenda Crabtree-Ramírez

Keyword(s):

Emergency Department ◽

Time Series ◽

Hiv Testing ◽

Teaching Hospital ◽

Educational Intervention ◽

Temporal Trends ◽

Hiv Screening ◽

Hiv Diagnosis ◽

Post Intervention ◽

Hiv Test

Abstract Background Among 230,000 people living with HIV in Mexico, 24% are unaware of their diagnosis, and half of newly diagnosed individuals are diagnosed with advanced disease. Early diagnosis is the goal to mitigate HIV epidemic. Missed opportunities may reflect a lack of clinicians’ consideration of HIV screening as part of routine medical care. We assessed whether an educational intervention on residents was effective to 1) improve the knowledge on HIV screening; 2) increase the rate of HIV tests requested in the hospitalization floor (HF) and the emergency department (ED); and 3) increase HIV diagnosis in HF and ED. Methods Internal Medicine and Surgery residents at a teaching hospital were invited to participate. The intervention occurred in August 2018 and consisted in 2 sessions on HIV screening with an expert. A questionnaire was applied before (BQ) and after (AQ) the intervention, which included HIV screening indications and clinical cases. The Institutional Review Board approved this study. Written informed consent was obtained from all participants. BQ and AQ scores were compared with a paired t-test. To evaluate the effect on HIV test rate in the HF and ED, an interrupted time series analysis was performed. Daily rates of tests were obtained from September 2016 to August 2019 and plotted along time. Restricted cubic splines (RCS) were used to model temporal trends. HIV diagnosis in HF and ED pre- and post-intervention were compared with a Fisher’s exact test. A p< 0.05 was considered significant. Results Among 104 residents, 57 participated and completed both questionnaires. BQ score was 79/100 (SD±12) and AQ was 85/100 (SD±8), p< .004. Time series of HIV testing had apparent temporal trends (Fig 1). HIV test rate in the HF increased (7.3 vs 11.1 per 100 episodes) and decreased in the ED (2.6 vs 2.3 per 100 episodes). HIV diagnosis increased in the HF, from 0/1079 (0%) pre-intervention to 5/894 (0.6%) post-intervention (p< .018) (Table 1). Fig 1. HIV test rates. Gray area represents post-intervention period. Table 1. Description of episodes, HIV tests and rates pre- and post-intervention in the Emergency Department and Hospitalization Floor. Conclusion A feasible educational intervention improved residents’ knowledge on HIV screening, achieved maintenance of a constant rate of HIV testing in the HF and increased the number of HIV diagnosis in the HF. However, these results were not observed in the ED, where administrative barriers and work overload could hinder HIV screening. Disclosures All Authors: No reported disclosures

Download Full-text

1294. Long-Term Impact of an HIV Testing Program on High-Risk HIV Screening in the Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1157 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S466-S466

Author(s):

Jillian T Baron ◽

Alexis Schwartz ◽

Ebony Davis ◽

Julie E Uspal ◽

Brendan Kelly

Keyword(s):

Emergency Department ◽

High Risk ◽

Hiv Testing ◽

Retrospective Chart Review ◽

Hiv Screening ◽

Transmitted Infection ◽

Testing Program ◽

Sti Testing ◽

Hiv Test ◽

To Receive

Abstract Background Emergency Departments (EDs) are important sites for HIV testing. However, there is little guidance on how best to implement HIV testing in the ED. The purpose of this study was to evaluate HIV screening practices of high-risk individuals presenting to an ED in the absence (ED1) and in the presence (ED2) of an established HIV testing program within the same academic hospital. Methods We performed a retrospective chart review of all individuals 18 years or older presenting to either ED between January 1, 2016 and December 31, 2018. High-risk of HIV infection was determined by receipt of bacterial sexually transmitted infection (STI) testing for Neisseria gonorrhoeae or Chlamydia trachomatis. The primary outcome was receipt of any HIV test in the ED. Overall proportions of patients tested for HIV at the same time of STI testing were compared between sites by chi-square test. Predictors of HIV testing were analyzed by logistic regression. Results During the study period, 7,956 individuals received STI testing at ED1 and 10,815 received STI testing at ED2. The majority of individuals receiving STI testing at both sites were female, 81.2% at ED1 and 66.4% at ED2 (P <0.001). Only 4.0% of individuals received HIV testing at ED1 compared with 47.4% at ED2 (P <0.001). Individuals were significantly more likely to receive HIV testing at the time of STI testing in the ED with an HIV testing program (aOR 19.66, 95% CI 17.28–22.37). In the ED without an HIV testing program, individuals were more likely to receive HIV testing if they were male (aOR 3.57, 95% CI 2.78–4.55) and less likely if they were black (aOR 0.57, 95% CI 0.50–0.97). In the ED with an HIV testing program, individuals were more likely to receive HIV testing if they were male (aOR 2.17, 95% CI 1.92–2.44) and more likely if they were black (aOR 1.74, 95% CI 1.37–2.20). Conclusion Overall, the presence of an HIV testing program in the ED significantly increased the probability that individuals would receive an HIV test at the time of bacterial STI testing and mitigated disparities in care. The results of this study will help guide ongoing interventions to improve HIV screening among high-risk individuals in the emergency department. Disclosures All authors: No reported disclosures.

Download Full-text

An Electronic Alert for HIV Screening in the Emergency Department Increases Screening but not the Diagnosis of HIV

Applied Clinical Informatics ◽

10.4338/aci-2013-09-ra-0075 ◽

2014 ◽

Vol 05 (01) ◽

pp. 299-312 ◽

Cited By ~ 7

Author(s):

N. Liu ◽

J. Sperling ◽

R. Green ◽

S. Clark ◽

D. Vawdrey ◽

...

Keyword(s):

Emergency Department ◽

New York ◽

Hiv Testing ◽

Intervention Group ◽

Hiv Screening ◽

Intervention Period ◽

Post Intervention ◽

Hiv Test ◽

The Impact ◽

Post Intervention Group

SummaryObjective: Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13–64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals.Methods: During the pre-intervention period (2.5–4 months), an electronic “HIV Testing” order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert.Results: The percentage of visits where an HIV test was performed increased from 5.4% in the pre-intervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%).Conclusions: An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.Citation: Schnall R, Liu N, Sperling J, Green R, Clark S, Vawdrey D. An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV. Appl Clin Inf 2014; 5: 299–312 http://dx.doi.org/10.4338/ACI-2013-09-RA-0075

Download Full-text

954. Missed opportunities for HIV Screening in the Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1140 ◽

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

Download Full-text

Evaluation of HIV screening at antenatal care settings in Denpasar City

Public Health and Preventive Medicine Archive ◽

10.15562/phpma.v5i1.39 ◽

2017 ◽

Vol 5 (1) ◽

pp. 33

Author(s):

Putu Cintya Denny Yuliyatni ◽

Wayan Pujana ◽

Citra Indriani

Keyword(s):

Public Health ◽

Pregnant Women ◽

Hiv Testing ◽

Health Centre ◽

Secondary Data ◽

Performance Outcomes ◽

Hiv Screening ◽

Public Health Centre ◽

Key Informants ◽

Hiv Test

Background and purpose: National strategy to increase the coverage of prevention of mother to child transmission (PMTCT) program in Indonesia is integrating the service into public health centres (puskesmas). In Bali, the integration has been started since 2014. After one year of program implementation, an evaluation was conducted in order to provide input and feedback for program improvement.Methods: Secondary data analysis and indepth interview with 13 key informants in Denpasar City were conducted to assess input, process and output of the integration implementation. Results: Of the 11,719 pregnant women targeted within the program, 43% were offered to undergo HIV testing and 98% of these agreed to have HIV test with 17 were found HIV positive. Interviews with key informants found that there were adequate resources both in terms of manpower, funds and equipment. Obstacles found in the implementation include different site of ANC and HIV testing facility. The other barrier was high number of pregnant mother who conducted ANC at private obstetrician which not yet included in the program.Conclusions: Integration of PMTCT into ANC services at public health centre (PHC) is an effective way to improve the uptake of HIV screening among pregnant women. However, there is a need of effective of referral systems from private midwives and PHC satellite services. The expansion of networks into private midwives and obstetrician will be instrumental in improving performance outcomes.

Download Full-text

Patient Perceptions and Acceptance of Routine Emergency Department HIV Testing

Public Health Reports ◽

10.1177/00333549081230s304 ◽

2008 ◽

Vol 123 (3_suppl) ◽

pp. 21-26 ◽

Cited By ~ 63

Author(s):

Jeremy Brown ◽

Irene Kuo ◽

Jennifer Bellows ◽

Ryan Barry ◽

Peter Bui ◽

...

Keyword(s):

Emergency Department ◽

African American ◽

Hiv Testing ◽

Acceptance Rate ◽

Patient Acceptance ◽

Hiv Screening ◽

Asian Patients ◽

Academic Center ◽

Hiv Test ◽

High Prevalence

Objectives. We report on the rates of patient acceptance and their perceptions of routine emergency department (ED) human immunodeficiency virus (HIV) testing in a high-prevalence area. Methods. We analyzed the race/ethnicity of patients who either accepted or declined a routine HIV test that was offered to all patients in the ED of a large academic center. We also distributed a patient perception survey about ED HIV testing. Results. During the study period, an HIV screening test was offered to 9,826 patients. Of these, 5,232 patients (53%) accepted the test. The acceptance rate of HIV testing was highest among African American patients (55%), followed by 52% for white, 50% for Hispanic, and 42% for Asian patients. A total of 1,519 completed surveys were returned for analysis. The most common reasons for declining a test were that patients did not perceive themselves to be at risk for HIV (49%) or they had recently been tested for HIV (18%). Overall, 84% of patients stated they would recommend to a friend to get an HIV test in the ED. When analyzed by ethnicity, 89% of African American patients stated they would recommend to a friend to get an HIV test if the friend went to the ED, but only 74% of white patients would do so. Conclusions. The Centers for Disease Control and Prevention's 2006 recommendations on HIV screening are well accepted by the target populations. Further work at explaining the risk of HIV infection to ED patients should be undertaken and may boost the acceptance rate of ED HIV screening.

Download Full-text

Evaluation of HIV screening at antenatal care settings in Denpasar City

Public Health and Preventive Medicine Archive ◽

10.24843/phpma.2017.v05.i01.p07 ◽

2017 ◽

pp. 41

Author(s):

P. Cintya Denny Yuliyatni ◽

W. Pujana ◽

C. Indriani

Keyword(s):

Public Health ◽

Pregnant Women ◽

Hiv Testing ◽

Health Centre ◽

Secondary Data ◽

Performance Outcomes ◽

Hiv Screening ◽

Public Health Centre ◽

Key Informants ◽

Hiv Test

Background and purpose: National strategy to increase the coverage of prevention of mother to child transmission (PMTCT) program in Indonesia is integrating the service into public health centres (puskesmas). In Bali, the integration has been started since 2014. After one year of program implementation, an evaluation was conducted in order to provide input and feedback for program improvement.Methods: Secondary data analysis and in depth interview with 13 key informants in Denpasar City were conducted to assess input, process and output of integration implementation.Results: Of the 11,719 pregnant women targeted within the program, 43% were offered to undergo HIV testing and 98% of these agreed to have HIV test with 17 were found HIV positive. Interviews with key informants found that there were adequate resources both in terms of manpower, funds and equipment. Obstacles found in the implementation includes different site of ANC and HIV testing facility. The other barrier was high number of pregnant mother who conducted ANC at private obstetrician which not yet included in the program.Conclusions: Integration of PMTCT into ANC services at public health centre (PHC) is an effective way to improve the uptake of HIV screening among pregnant women. However, there is a need for effective of referral systems from private midwives and PHC satellite services. The expansion of networks into private midwives and obstetrician will be instrumental in improving performance outcomes.

Download Full-text

Healthcare resource Utilization among Hispanic Adults relative to Non-Hispanic White Adults in the US

Value in Health ◽

10.1016/j.jval.2015.03.471 ◽

2015 ◽

Vol 18 (3) ◽

pp. A81

Author(s):

M. Hopps ◽

M. Udall ◽

G. Makinson ◽

M. McDonald ◽

J. Mardekian

Keyword(s):

Resource Utilization ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Hispanic Adults ◽

The Us ◽

White Adults ◽

Hispanic White

Download Full-text

Implementing a Novel Citywide Rapid HIV Testing Campaign in Washington, D.C.: Findings and Lessons Learned

Public Health Reports ◽

10.1177/003335491212700410 ◽

2012 ◽

Vol 127 (4) ◽

pp. 422-431 ◽

Cited By ~ 26

Author(s):

Amanda D. Castel ◽

Manya Magnus ◽

James Peterson ◽

Karishma Anand ◽

Charles Wu ◽

...

Keyword(s):

Focus Groups ◽

Hiv Testing ◽

Black People ◽

Scale Up ◽

Qualitative Evaluation ◽

Lessons Learned ◽

Hiv Care ◽

Hiv Screening ◽

Hiv Test ◽

Rapid Hiv Test

Objectives. In June 2006, the District of Columbia (DC) Department of Health launched a citywide rapid HIV screening campaign. Goals included raising HIV awareness, routinizing rapid HIV screening, identifying previously unrecognized infections, and linking positives to care. We describe findings from this seminal campaign and identify lessons learned. Methods. We applied a mixed-methods approach using quantitative analysis of client data forms (CDFs) and qualitative evaluation of focus groups with DC residents. We measured characteristics and factors associated with client demographics, test results, and community perceptions regarding the campaign. Results. Data were available on 38,586 participants tested from July 2006 to September 2007. Of those, 68% had previously tested for HIV (44% within the last 12 months) and 23% would not have sought testing had it not been offered. Overall, 662 (1.7%) participants screened positive on the OraQuick® Advance™ rapid HIV test, with non-Hispanic black people, transgenders, and first-time testers being significantly more likely to screen positive for HIV than white people, males, and those tested within the last year, respectively. Of those screening positive for HIV, 47% had documented referrals for HIV care and treatment services. Focus groups reported continued stigma regarding HIV and minimal community saturation of the campaign. Conclusions. This widespread campaign tested thousands of people and identified hundreds of HIV-infected individuals; however, referrals to care were lower than anticipated, and awareness of the campaign was limited. Lessons learned through this scale-up of population-based HIV screening resulted in establishing citywide HIV testing processes that laid the foundation for the implementation of test-and-treat activities in DC.

Download Full-text

1299. Cluster of False-Positive “Fifth-Generation” HIV Test Results During Implementation of a Routine HIV Screening Program in an Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1162 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S468-S468

Author(s):

Andrew B Trotter ◽

Anjana Maheswaran ◽

Mary Kate Mannion ◽

Sara Baghikar ◽

Janet Lin

Keyword(s):

Emergency Department ◽

Hiv Testing ◽

False Positive ◽

Screening Program ◽

False Positives ◽

Hiv Screening ◽

Fifth Generation ◽

Hiv Test ◽

Hiv Antigen ◽

Hiv 1

Abstract Background In November 2014, the University of Illinois Hospital (UI Health) introduced an electronic medical record (EMR)-driven HIV screening program in the emergency department (ED). In October 2016, our hospital laboratory introduced “Fifth-generation” HIV testing using the Bio-Rad BioPlex 2200 HIV Antigen/Antibody diagnostic assay. Fifth-generation HIV testing has the advantage of separately detecting and reporting HIV antibody and HIV-1 p24 antigen. Although the literature and manufacturer report high sensitivity and specificity of this test, we encountered higher than expected rates of false-positive tests during the introduction of this test. Methods We retrospectively reviewed the results of our ED HIV screening program from October 2016 to March 2019 to describe the outcomes of HIV testing, determine the rates of false-positive HIV tests and determine if false-positive rates were temporally clustered. We also investigated various potential causes of higher than expected false positives including pre-analytical and analytical error. We defined a false-positive test as a repeatedly reactive initial HIV antigen and/or HIV-1 antibody result with a subsequent negative or indeterminate HIV-1/2 antibody differentiation immunoassay and negative HIV-1 nucleic amplification test. Results During the review period, out of a total of 17,385 HIV tests which were performed, 85 tests were confirmed positive and 27 were false positives. This represents an HIV prevalence of 0.5%. Eighteen of the 27 false positives occurred during an 8 month period between October 2016 and April 2017 (see Figure 1). During our investigation of potential causes of the false-positive tests, we discovered that a reagent lot for the test was changed in June 2017 which resulted in a significant decrease in the false-positive rate (0.33% to 0.07%). Conclusion We provide data which suggests that a reagent lot may have been the cause of higher than expected false-positive tests for HIV testing. Monitoring of testing outcomes during implementation of a routine HIV testing program can help identify potential root causes of false-positive tests. Disclosures All authors: No reported disclosures.

Download Full-text