378 Expanding HIV Testing to Regional Emergency Departments Identifies Community HIV Cases

Abstract

In the United States, the Centers for Disease Control and Prevention (CDC) estimates that 1.1 million people aged 13 and older are currently living with an HIV infection, and approximately 14% of these were undiagnosed and unaware of their HIV infection (2016 estimate). Expanded 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. The ED is a frequent health care access point for underserved, at-risk populations at high risk for HIV infection, and these populations utilize ED services for evaluation of sexually transmitted diseases. Our aim was to see whether increasing system-wide access to efficient HIV testing in the ED would improve detection of HIV in the community setting. Starting in January 2020, our health system in northeast Ohio expanded availability of rapid lab-based HIV testing from beyond the urban main campus to 11 community hospital EDs. Collaboration with laboratory medicine and infectious disease permitted these EDs to offer rapid lab-based HIV testing patients presenting with STIs or other clear HIV risk factors. For each preliminary positive test, a confirmatory test was reflexively run using blood samples obtained from the initial draw. Data was collected through an EMR query using a series of EPIC lab order codes for all ED encounters in the health system between January 1 and May 2, 2020 for which a rapid HIV test was ordered in the ED. Data query included test results, patient demographic information, ED location, and time of patient arrival to ED. Proportions and p values (Chi Square) are reported. There were a total of 326 distinct ED encounters in which a rapid HIV test was performed across the 12 health system EDs. The mean age of patients was 29.9 years (SD = 11.7), and 172 (52.8%) were male. Overall, there were 11 reactive tests (3.4%). 234/326 (71.8%) of encounters with a rapid HIV test occurred at community EDs, with a median of 18 tests (SD: 11.8) being performed over the study period at each location. There was no difference in the prevalence of HIV positive tests between community and urban settings (7/234; 3.0% positive tests community vs. 4/92; 4.3% positive Main Campus urban tertiary care center, X2 (1, N = 326) = 0.36, p = .54). Expanding rapid HIV testing to community EDs in a regional health system identified additional previously unrecognized patients who tested positive for HIV, with a similar proportion of positive tests at the urban main campus ED as community EDs.Tabled 1EDDistinct ED EncountersRapid Test Reactive Results1 (community)1212 (community)303 (community)3634 (community)2315 (community -pediatric ED)1206 (community)907 (community - pediatric ED)1418 (community)2309 (community)42010 (urban tertiary care center)92411 (community)22012 (community)3013 (community)24114 (community)110Total32611 Open table in a new tab