243 Emergency Department Sexually Transmitted Infection Testing and Compliance With CDC HIV Testing Guidelines in a National Sample of Emergency Departments

Abstract

At the end of 2016, the Centers for Disease Control and Prevention (CDC) estimated that 1.1 million people aged 13 and older were living with HIV infection in the United States, and that approximately 14% of these were undiagnosed and unaware of their HIV infection. Earlier testing programs including those provided in the emergency department (ED) may lead to earlier detection and further reduction in the transmission of HIV. CDC and United States Preventative Services Task Force (USPSTF) 2013 guidelines recommend screening for HIV in adolescents and adults aged 15-65 as well as younger adolescents and older adults at high risk. Patients who have a lab test for gonorrhea (GC) and chlamydia represent a high-risk patient population. While the ED is a frequent health care access point for patients seeking evaluation for sexually transmitted diseases, ED providers may not be following guidelines for HIV testing in high risk patients. Our aim was to assess the compliance with CDC and USPSTF guidelines for HIV testing in a national sample of emergency departments. We examined ED data from 2010-2015 using the Nationwide Emergency Department Sample (NEDS); the NEDS is the largest all-payer ED database in the US and can be used to create national estimates of ED care. Current Procedural Terminology (CPT) codes were used to query GC, chlamydia, HIV and syphilis testing. Weighted proportions and 95% confidence intervals are reported, and Rao-Scott chi-square tests were used to compare proportions. We identified a total of 153,594,597 ED visits (weighted N= 693,918,859). Testing for sexually transmitted infections (STI) was done in 1.5% (95% CI: 1.4, 1.7) of visits and was more common amongst females (2.2% vs. 0.74% p<0.001). HIV screening was done in 0.25% (95% CI: 0.19, 0.31) of all visits and this was consistent across sex. GC and/or chlamydia testing was done in 1.3% (95% CI: 1.2, 1.4) of all visits. Among this high-risk population, 1.8% (95% CI: 1.4. 2.3) received HIV testing without syphilis screen, 1.3% (95% CI: 1.1, 1.6) received syphilis screen without HIV, and 0.96% (95% CI: 0.81, 1.1) received both HIV and syphilis screening as per CDC and USPSTF guidelines. Amongst the high-risk population, screening for HIV and/or syphilis was significantly higher among males than females (HIV with or without syphilis testing 5.4% vs. 2.3% p<0.001, syphilis testing with or without HIV test 6.7% vs. 1.5% p<0.001, both HIV and syphilis testing 2.3% vs. 0.72% p<0.001). In spite of CDC and USPSTF recommendations for HIV screening in patients undergoing evaluation for STIs, only a very small proportion of subjects are being tested in the ED. In addition, emergency physicians are more likely to order HIV and syphilis testing in males undergoing GC/chlamydia testing. Further studies exploring barriers to HIV screening in patients undergoing STI assessment in the ED may help inform future projects aimed at increasing guidance compliance.