Abstract
IntroductionWith the current hepatitis C (HCV) epidemic in the Appalachian region and the risk of human immunodeficiency virus (HIV) co-infection, there is a need for increased secondary prevention efforts. The purpose of this study was to implement routine HIV and HCV screenings in the urgent care setting through the use of an electronic medical record (EMR) to increase a provider’s likelihood of testing eligible patients.MethodsFrom June 2017 through May 2018, EMR-based HIV and HCV screenings were implemented in three emergency department-affiliated urgent care settings: a local urgent care walk-in clinic; a university-based student health services center; and an urgent care setting located within a multi-specialty clinic. EMR best practice alerts (BPA) were developed based on Centers for Disease Control and Prevention (CDC) guidelines and populated on registered patients who qualified to receive HIV and/or HCV testing. Patients were excluded from the study if they chose to opt out from testing or the provider deemed it clinically inappropriate. Upon notification of a positive HIV and/or HCV test result through the EMR, patient navigators (PNs) were responsible for linking patients to their first medical appointment.ResultsFrom June 2017 through May 2018, 48,531 patients presented to the three urgent care clinics. Out of 27,230 eligible patients, 1,972 patients (7.2%) agreed to be screened for HIV; for HCV, out of 6,509 eligible patients, 1,895 (29.1%) agreed to be screened. Thirty-one patients (1.6%) screened antibody-positive for HCV, with three being ribonucleic acid confirmed positives. No patients in either setting were confirmed positive for HIV; however, two initially screened HIV-positive. PNs were able to link 17 HCV antibody-positive patients (55%) to their first appointment, with the remainder having a scheduled future appointment.ConclusionIntroducing an EMR-based screening program is an effective method to identify and screen eligible patients for HIV and HCV in Appalachian urgent care settings where universal screenings are not routinely implemented.
Highlights
With the current hepatitis C (HCV) epidemic in the Appalachian region and the risk of human immunodeficiency virus (HIV) co-infection, there is a need for increased secondary prevention efforts
From June 2017 through May 2018, electronic medical record (EMR)-based HIV and Hepatitis C virus (HCV) screenings were implemented in three emergency department-affiliated urgent care settings: a local urgent care walk-in clinic; a university-based student health services center; and an urgent care setting located within a multi-specialty clinic
From June 5, 2017—May 31, 2018, a total of 48,531 patients presented to the three urgent care clinics, with the majority (51%) presenting to the local, stand-alone urgent care clinic
Summary
With the current hepatitis C (HCV) epidemic in the Appalachian region and the risk of human immunodeficiency virus (HIV) co-infection, there is a need for increased secondary prevention efforts. HIV-HCV Screenings in Acute Care for Disease Control and Prevention (CDC) recommendations.[3] Recently, an HCV epidemic related to injection of opioids has led to a sharp increase in incident cases in the U.S. Central Appalachia (Kentucky, Tennessee, Virginia, West Virginia) has been hard hit by this epidemic, with observed cases of HCV increasing 364% between 2006 and 2012.4,5 A recent study has demonstrated a need for further HCV testing and intervention in the Appalachian region.[6] Among Central Appalachia states, West Virginia currently has the second-highest incident rate of HCV in the nation.[4] Of particular concern is the fact that HCV co-infection has been observed in rates as high as 90% among human immunodeficiency virus (HIV) positive injection drug users.[7] West Virginia has historically had a low HIV prevalence, there has recently been an alarming increase of HIV cases in the state.[8] This increase, coupled with the HCV epidemic, demonstrates the need for established screening efforts to help halt the cycle of transmission of HIV and HCV.[7]
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