Using the electronic medical record to increase testing for HIV and hepatitis C virus in an Appalachian emergency department

Judith Feinberg,Carmen N. Burrell,Justin Burns,Stephen Davis,Julia Nist,Owen Lander,Ian B. K. Martin,Melinda J. Sharon,Elena M. Wojcik,Valerie Boley

doi:10.1186/s12913-021-06482-5

Judith Feinberg, Carmen N. Burrell + Show 8 more

Open Access

https://doi.org/10.1186/s12913-021-06482-5

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Abstract

BackgroundThe ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed. The primary aim of this study was to assess the potential increase in screening for HIV and HCV in an academic central Appalachian emergency department (ED) through the use of Best Practice Alerts (BPAs) in the electronic medical record (EMR). A secondary aim was to assess for an increase in linkage to care using patient navigators.MethodsEMR algorithms based on current Centers for Disease Control and Prevention HIV and HCV testing recommendations were created that triggered Best Practice Alerts (BPAs), giving providers a one-click acceptance option to order HIV and/or HCV testing. Placards were placed in care areas, informing patients of the availability of routine screening. Patient navigators facilitated linkage to care for seropositive patients.ResultsThe BPA appeared 58,936 times on 21,098 patients eligible for HIV screening and 24,319 times on 11,989 patients eligible for HCV screening over a one-year period. Of those, 7106 (33.7%) patients were screened for HIV and 3496 (29.2%) patients were screened for HCV, for an overall testing increase of 2269% and 1065% for HIV and HCV, respectively. Linkage to care increased by 15% for HIV to 100, and 14% for HCV to 64%.ConclusionHIV and HCV screening and linkage to care were increased in an academic ED setting in central Appalachia using EMR alerts. This approach could be utilized in multiple ambulatory settings. Increased testing and earlier linkage to care may help combat the current injection drug use-related HCV epidemic and avoid additional HIV outbreaks.

Highlights

The ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed
Prior to implementation, approximately 300 HIV screenings and 300 HCV screenings were conducted in the emergency department (ED) between July 2015 and July 2016, and only 85 and 50% respectively of those with positive results were linked to care as a result of testing
The Best Practice Alert (BPA) appeared approximately 24,319 times on 11, 989 patients eligible for HCV screening based on risk factors or lack of prior screening, for a rate of 2.0 times per patient

Summary

Introduction

The ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed. Injection drug use (IDU) is the primary driver of HCV infection and accounts for 60 to 70% of incident cases in the U.S and other countries [4, 5]. Between 2006 and 2012, central Appalachia (Kentucky, Tennessee, Virginia and West Virginia) observed a 364% increase in acute HCV cases [6]. During this same time period, admissions to treatment for opioid use disorder in these states increased from 8.6 to 12% [6]. In 2020, the CDC again updated the HCV screening guidelines to include a once in a lifetime screening for all adults 18 years of age and older except where the prevalence of the disease is < 0.1%, with additional testing for anyone with known risk factors [9]

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