181 Clinical Knowledge of Human Immunodeficiency Virus Among Emergency Providers at Two Level 1 Trauma Centers in Cleveland, Ohio

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Emergency departments (ED) are targeted areas for prevention and diagnosis of early human immunodeficiency virus (HIV) and sexually transmitted infections (STI) given increased prevalence in this setting. Clinical knowledge and recognition of these diseases is required for identifying those at risk. Previous studies show that STI knowledge is sup-optimal among general practitioners, and acute HIV infection is frequently misdiagnosed in the ED. The purpose of this study was to assess the correlation between self-reported STI knowledge and HIV test ordering practices among emergency medicine providers in a survey study of simulated scenarios. We modified 2 surveys previously published in the literature that assess knowledge of acute HIV infection and STIs. The survey was divided into 2 sections: a 29-point score for STIs and a 10-point score for HIV. This modified survey was administered to all emergency physicians, residents, and advanced practice providers affiliated with 2 level 1 trauma centers in Cleveland, Ohio. The primary outcome of ordering an HIV test was analyzed using Spearman’s correlation coefficient (SC) to assess strength of correlation with STI knowledge. Subgroup analyses were conducted using SC and ANOVA. This study was powered to estimate the SC using an effect size of 0.3 at an alpha of 0.05 for 90% power requiring a sample size of 90 respondents. A total of 75 providers (31.3%) completed the survey. Respondents were primarily physicians (54.6%), male (56%), white (83.7%), with a median of 8 years in practice (IQR: 2,16). The majority of respondents (57%) report formal HIV training as part of their professional education. Spearman’s correlation of HIV and STIs showed a monotonic relationship with a weak positive correlation (r = 0.3513, p = 0.002). A similar analysis comparing length of time as an emergency medicine provider with HIV and STI scores was monotonic with a weak negative correlation that was not statistically significant. There was no association between HIV scores and provider type (p=0.67) or provider sex (p=0.89); however, those with formal HIV training scored higher than those without formal HIV training (p=0.003). There was no association between STI scores and provider type (p=0.10) or provider sex (p=0.79). The movement in emergency medicine to screen patients at risk of undiagnosed HIV focuses on universal or targeted screening. The results of our study reveal that when presented with a patient at high-risk for undiagnosed HIV or with undiagnosed symptomatic HIV infection, most providers either do not screen or do not have HIV in the differential diagnosis. Similarly, knowledge of STIs is only weakly correlated with knowledge of HIV risk factors and symptomatic HIV infection. Further research and screening efforts may benefit by focusing on HIV education among EM providers.