HIV-testing in a cancer center emergency department.

Abstract

225 Background: HIV is a cancer-associated virus classically associated with KS, NHL, and cervical cancer, but more recently with anal cancer, lung, and head and neck cancers. HIV testing and treatment are important for cancer patients for three reasons: 1) HIV treatment is associated with reduced transmission of a cancer-associated virus. 2) HIV treatment is associated with improved outcomes of cancer therapy in many cancers. 3) HIV testing optimizes quality of care, since testing is recommended by the Centers for Disease Control and Prevention (CDC) and the US Preventive Services Task Force (USPSTF)(A level recommendation) for patients between the ages of 15 and 65 years of age. Since emergency centers (EC’s) commonly provide immunizations and other preventive care, we implemented HIV testing at our cancer center EC. Methods: In our 44 bed cancer center EC with approximately 25,000 annual visits, routine implementation by physician order was implemented in July 2014. EC information technology (IT) assisted in modification of the order sets and facilitated documentation of specific consent for HIV. Educational materials were disseminated to patients and EC providers. A new consent form with integration of HIV consent, including a check box to refuse HIV testing, was implemented on June 19, 2015. Testing results are described through August 2015. Results: HIV testing increased significantly from July 2014 and August 2015. The impact on institutional testing was considerable, increasing from 1.2% of all HIV testing in 2013 to 15.1% to date in 2015. Between July 2014 and August 2015, 1.4% (0.4% incident) of 852 patients screened positive for HIV. Notably, 83% of patients agreed to HIV testing, but less than 20% of patients were actually tested. The highest refusal rate (18.8%) was in patients over age 70 and lowest (9.9%) in those 21-29 years of age. Conclusions: Routine HIV testing is feasible in a comprehensive cancer center ED, but increased awareness is necessary to optimize testing, given the high acceptance rate. Seroprevalence of HIV is comparable to non-cancer center EC’s (0.5-1.2%). These results demonstrate the acceptance by patients of testing for HIV, with implications in reduction of transmission of this cancer-associated virus.