388 Implementation of an Emergency Department Syphilis and HIV Point-of-Care Screening Process During an Outbreak of Syphilis in Detroit, MI in Collaboration With the Infectious Disease Department and the Centers for Disease Control and Prevention

Abstract

The number of primary and secondary syphilis cases in Detroit, Michigan increased from 73 in 2010 to 199 to 2013. Cases were predominantly in young African American men with who have sex with men and with had a high rate of HIV co-infection. The infectious disease (ID) department at Henry Ford Hospital (HFH), in collaboration with the Centers for Disease Control and Prevention (CDC) determined the emergency department (ED) would be the optimal setting to implement a screening program. Young men in Detroit are typically non-health care seeking; however, EDs are venues they do frequent when they access the health care system. We hypothesized that the implementation of an ED screening model would detect an increased number of syphilis and HIV cases than were seen with standard care. Point-of-care (POC) testing would allow presumptive treatment of active syphilis cases in the emergency department, whereas traditional testing would not typically result and allow for care within a typical ED visit time frame. Syphilis and HIV screening was offered to men aged 18-34 years seen in the HFH ED with an Emergency Severity Index (ESI) of 2-5. Dedicated, non-ED staff employed 2 rapid finger-stick POC tests: the Alere Determine HIV-1/2 Ag/ab Combo test (Determine) and the Syphilis Heath Check (SHC) treponemal tests. Participants also underwent venipuncture for standard lab-based testing for HIV and syphilis. Screening took place from 7:30am to 5pm, Monday through Friday. Patients were first approached by screeners, typically before the initial clinician contact and were offered screening. Confirmatory lab-based testing using the Biorad 4th generation HIV test, RPR, and TPPA tests were drawn in conjunction with ED nursing staff during their routine bloodwork. ED clinicians were notified of positive SHC POC testing and patients were treated presumptively in the ED. From 6/10/2015 to 3/11/2016, 871 patients were enrolled. Active syphilis (RPR + TPPA +) was identified in 6 (0.7%) participants, and newly diagnosed HIV in 7 (0.8%). There was one case of syphilis-HIV coinfection, and the combined prevalence was 1.4%. Three patients were treated in the ED for syphilis based on their POC testing results without treatment complications. The implementation of an ED syphilis and HIV POC screening program is a feasible method to detect new cases of disease. The screening process can be incorporated into ED patient flow and provide clinicians with immediate test results to determine the need for treatment. POC HIV and syphilis testing are particularly important to ED providers, who may not otherwise receive important test results for their patients before they leave the emergency department.