Valuable Hospital and Laboratory Practice in an Integrated Medical System for HIV Infection Prevention Interventions at a Veteran Affairs Medical Center (VAMC)

Abstract

Abstract Introduction/Objective Patient focused integrated health systems have been described in the literature as being more likely to obtain positive health outcomes in their patient populations. This has particularly been the case for screenings with follow-up interventions as necessary. The usefulness of an Integrated Medical System in optimizing quality medical care for HIV infection and in monitoring patients already on Pre-Exposure Prophylaxis (PrEP) has been previously discussed in the literature. However, when it comes to the screening and initial identification of HIV- negative patients who may benefit from HIV preventive therapies such as PrEP, the literature is sparse. Here we report the useful initial identification of potential patients in a VAMC. Methods As part of a quality assurance/improvement project, a search in Vista/Fileman from June 2018 to February 2020 was performed for all patients with a positive sexually transmitted disease (STD) test result - PCR testing for gonorrhea/chlamydia and RPR - during this time period. A medical chart review was performed to determine the HIV status of the patient, and if negative for HIV, whether PrEP was discussed with the patient by the clinical primary care team or the infectious disease consult. The number of patients who ultimately began PrEP as a result of this initial identification was tabulated. Results A total of 58 unique patients who tested positive for an STD were successfully identified as being potential candidates for PrEP by the clinical primary care teams or the infectious disease consult in the Integrated Medical System, and as a result the possibility of PrEP was discussed with all 58. In the end, 28 of these patients started PrEP interventions after discussion with their clinical providers. In all patients, these patients were initially identified by a positive STD test result. This is out of a total of 220 HIV negative patients that had been reviewed by their respective clinical providers upon being alerted by the computerized patient record system. Conclusion The Integrated Medical System at the VAMC successfully screened and identified patients who may benefit from PrEP. This is a significant example of an integrated medical system successfully screening and providing quality care for identified patients who otherwise would not have had this health preserving intervention.