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Kapadia SN, Singh HK, Jones S, Merrick S, Vaamonde CM. Missed Opportunities for HIV Testing of Patients Tested for Sexually Transmitted Infections at a Large Urban Health Care System From 2010 to 2015. Open Forum Infect Dis 2018; 5:ofy165. [PMID: 30087904 PMCID: PMC6059204 DOI: 10.1093/ofid/ofy165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background Appropriate testing of people at risk for HIV is an important piece of the HIV care continuum. We analyzed HIV testing patterns of patients tested for gonorrhea and chlamydia (GC/CT) at a large urban health care system in New York City. Methods We retrospectively studied HIV and GC/CT testing from 2010 to 2015. Data were collected from a clinical laboratory database and linked to electronic health records. Patients were older than age 13 years, not known to be HIV positive, and had had a GC/CT test. The main outcome was the proportion of patients who had both HIV and GC/CT testing performed at the same encounter. Results We analyzed 85 768 patients with 139 404 GC/CT testing encounters. Most of the testing encounters (88% for men and 94% for women) were in the outpatient setting. Same-day HIV testing improved from 59% in 2010 to 70% in 2015 for male patients, and from 41% to 51% for female patients. In multivariate regression, male sex was associated with receipt of an HIV test (odds ratio [OR], 2.49; P < .001). Emergency department (OR, 0.22; P < .0001) and inpatient (OR, 0.10; P < .0001) locations were negatively associated with receipt of HIV testing. Among patients with HIV and GC/CT testing at the same encounter, 37 were HIV positive. Conclusions Concurrent HIV testing of patients being evaluated for GC/CT increased from 2010 to 2015. However, many patients failed to receive HIV testing, especially in emergency and inpatient settings. There continue to be missed opportunities for diagnosis of HIV among individuals with ongoing high-risk behavior.
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Affiliation(s)
- Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
| | - Harjot K Singh
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
| | - Sian Jones
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
| | - Samuel Merrick
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
| | - Carlos M Vaamonde
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
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Nyaku AN, Williams LM, Galvin SR. Comparison of HIV Testing Uptake in an Urban Academic Emergency Department Using Different Testing Assays and Support Systems. AIDS Patient Care STDS 2016; 30:166-9. [PMID: 26982908 DOI: 10.1089/apc.2015.0297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite 2006 recommendations by the Centers for Disease Control and Prevention for opt-out HIV testing in all healthcare settings, Emergency Department (ED) testing has been limited. We conducted an observational cohort study to assess the impact of two workflow interventions on the proportion of HIV tests ordered in an urban academic ED. First, a 4(th)-generation HIV antigen/antibody combination test replaced the existing assay, and ED staff continued to notify patients of their reactive tests. Six months later, the HIV Rapid Diagnosis Team, composed of an Infectious Diseases (ID) physician and the HIV Advanced Practice Nurse, immediately assisted with disclosure of positive results to the patients and facilitated linkage to outpatient care. The new assay did not change the proportion of HIV tests ordered (0.14-0.11%, χ2, p = 0.2). However, ID support was associated with a statistically significant increase in the proportion of HIV tests ordered (0.14-0.43%, χ2, p < 0.00010) and a nonstatistically significant increase in the proportion of new HIV diagnoses (1.6-6.8%, Fisher exact test = 0.113). Male gender and lack of insurance were associated with a reactive HIV test. Reduction of barriers to linkage to outpatient HIV care through a collaborative relationship between the ED and ID team increased HIV testing and diagnosis. The role of this model as a component of a universal HIV screening program will need to be further assessed.
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Affiliation(s)
- Amesika N. Nyaku
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa M. Williams
- Department of Medicine Nursing, Northwestern Memorial Hospital, Chicago, Illinois
| | - Shannon R. Galvin
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Allison WE, Chiang W, Rubin A, Oshva L, Carmody E. Knowledge about Hepatitis C Virus Infection and Acceptability of Testing in the 1945-1965 Birth Cohort (Baby Boomers) Presenting to a Large Urban Emergency Department: A Pilot Study. J Emerg Med 2016; 50:825-831.e2. [PMID: 26954104 DOI: 10.1016/j.jemermed.2016.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/20/2016] [Accepted: 02/03/2016] [Indexed: 12/09/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is responsible for the most common chronic bloodborne infection in the United States. The Centers for Disease Control (CDC) recently recommended screening all patients born between 1945-1965 (baby boomers) at least once for HCV infection. New York State has since mandated screening of baby boomers for HCV in nearly all patient care settings and encouraged it in the emergency department (ED). OBJECTIVES This pilot study aimed to ascertain acceptability of an HCV screening test among the 1945-1965 birth cohort presenting to the ED in advance of a study investigating the prevalence of HCV infection in this birth cohort in the ED setting. METHODS We conducted a cross-sectional study of health knowledge about HCV and government recommendations regarding HCV testing using a convenience sample of baby boomers in an ED in a large public hospital in the New York metropolitan area. Surveys were administered via a series of semistructured interviews. RESULTS There were 81 patient participants. Fifty-two percent of patients were born outside of the United States, 69% had a high school diploma level of education or lower, and 37% were unemployed. Patients demonstrated misconceptions about HCV transmission and curability and poor knowledge about the necessity of testing in their age cohort. Knowledge that "HCV can cause the liver to stop working" was significantly associated with acceptance of testing. CONCLUSIONS Baby boomers showed limited knowledge about the necessity of HCV screening in their age group, but testing for HCV infection in the ED was acceptable for the majority.
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Affiliation(s)
- Waridibo E Allison
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, New York
| | - William Chiang
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Ada Rubin
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Lillian Oshva
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Ellie Carmody
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, New York
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Benefits of a routine opt-out HIV testing and linkage to care program for previously diagnosed patients in publicly funded emergency departments in Houston, TX. J Acquir Immune Defic Syndr 2015; 69 Suppl 1:S8-15. [PMID: 25867782 DOI: 10.1097/qai.0000000000000578] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Routine Universal Screening for HIV program provides opt-out HIV testing and linkage to care for emergency department (ED) patients in Harris Health System, Houston, TX. Seventy-five percent of patients testing positive in this program have been previously diagnosed. Whether linkage to care is increased among these patients is unknown. METHODS We conducted a retrospective cohort study of persons tested for HIV in the ED between 2008 and 2012 but had a previously documented positive HIV test ≥1 year prior. Outcomes were engagement in care (≥1 HIV outpatient visits in 6 months), retention in care (≥2 HIV outpatient visits in 12 months, at least 3 months apart), and virologic suppression (<200 copies/mL in 12 months) compared before and after the ED visit. Analysis was conducted using McNemar test and multivariate conditional logistic regression. RESULTS A total of 202,767 HIV tests identified 2068 previously diagnosed patients. The mean age was 43 years with 65% male and 87% racial and ethnic minorities. Engagement in care increased from 41.3% previsit to 58.8% postvisit (P < 0.001). Retention in care increased from 32.6% previsit to 47.1% postvisit (P < 0.001). Virologic suppression increased from 22.8% previsit to 34.0% postvisit (P < 0.001). Analyses revealed that engagement in care after visit improved most among younger participants (ages 16-24 years), retention improved across all groups, and virologic suppression improved most among participants aged 25-34 years. CONCLUSIONS Routine opt-out HIV testing in an ED paired with standardized service linkage improves engagement, retention, and virologic suppression in previously diagnosed patients.
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Management of sexually transmitted infections in New York State health care organizations: who is thinking about the quality of STI care? Sex Transm Dis 2015; 41:519-24. [PMID: 25118963 DOI: 10.1097/olq.0000000000000171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rising rates of sexually transmitted infections (STIs) warrant a renewed focus on the management of STIs in health care organizations. The extent to which hospitals and community health centers (CHCs) have established processes and allocated staff for the management of STIs within their organizations remains poorly understood. METHODS A New York State Department of Health survey was distributed electronically through a closed state communication network to targeted administrators at New York State hospitals and CHCs. The survey asked if STI management in their facilities included the following: the ability to measure and report rates of STIs, a process to assess the quality of STI care and treatment outcomes, and a centralized person/unit to coordinate its work throughout the facility. Multivariate analysis was performed to identify whether organizational characteristics were associated with survey findings. RESULTS Ninety-five percent (243/256) of hospitals and CHCs responded to the survey. Fifty percent of respondents had a person or unit to report rates of STIs; 30% reported an organization-wide process for monitoring the quality of STI care, which, according to the multivariate analysis, was associated with CHCs; only 23% reported having a centralized person or unit for coordinating STI management. CONCLUSIONS Most facilities report STI cases to comply with public health surveillance requirements but do not measure infection rates, assess the quality of STI care, or coordinate its work throughout the facility. The development of this organizational capacity would likely decrease STI rates, improve treatment outcomes, and address local public health goals.
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Evaluating the New York State 2010 HIV testing law amendments: context, challenges, and conclusions. J Acquir Immune Defic Syndr 2015; 68 Suppl 1:S1-4. [PMID: 25545487 DOI: 10.1097/qai.0000000000000420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hallmark CJ, Skillicorn J, Giordano TP, Davila JA, McNeese M, Rocha N, Smith A, Cooper S, Castel AD. HIV testing implementation in two urban cities: practice, policy, and perceived barriers. PLoS One 2014; 9:e110010. [PMID: 25310462 PMCID: PMC4195679 DOI: 10.1371/journal.pone.0110010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown. METHODS We conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions. RESULTS In 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% of Department of Health-supported testers in Houston. The median number of tests per organization was 568 in DC and 1045 in Houston. Approximately 50% of organizations in both DC and Houston exclusively used opt-in consent and most conducted both pre- and post-test counseling with HIV testing (80% of organizations in DC, 70% in Houston). While the most frequent source of funding in DC was the Department of Health, Houston organizations primarily billed the patient or third-party payers. Barriers to testing most often reported were lack of funding, followed by patient discomfort/refusal with more barriers reported in DC. CONCLUSIONS Given unique policies, resources and programmatic contexts, DC and Houston have taken different approaches to support routine testing. Many organizations in both cities reported opt-in consent approaches and pre-test counseling, suggesting 2006 national HIV testing recommendations are not being followed consistently. Addressing the barriers to testing identified in each jurisdiction may improve expansion of testing.
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Affiliation(s)
- Camden J. Hallmark
- Houston Department of Health and Human Services, Houston, Texas, United States of America
- * E-mail:
| | - Jennifer Skillicorn
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC, United States of America
| | - Thomas P. Giordano
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jessica A. Davila
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Marlene McNeese
- Houston Department of Health and Human Services, Houston, Texas, United States of America
| | - Nestor Rocha
- HIV/AIDS, Hepatitis, STD, and TB Administration, District of Columbia Department of Health, Washington, DC, United States of America
| | - Avemaria Smith
- HIV/AIDS, Hepatitis, STD, and TB Administration, District of Columbia Department of Health, Washington, DC, United States of America
| | - Stacey Cooper
- HIV/AIDS, Hepatitis, STD, and TB Administration, District of Columbia Department of Health, Washington, DC, United States of America
| | - Amanda D. Castel
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC, United States of America
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Fitzpatrick LJ, Egan DJ, Cowan E, Savitsky LM, Kushner JD, Calderon Y, Agins BD. Nonoccupational post-exposure prophylaxis for HIV in New York State Emergency Departments. J Int Assoc Provid AIDS Care 2014; 13:539-46. [PMID: 25294854 DOI: 10.1177/2325957414553847] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
New York State (NYS) established guidelines for nonoccupational post-exposure prophylaxis (nPEP) to HIV in 1997. To assess current nPEP practices in NYS Emergency Departments (EDs), we electronically surveyed all ED directors in NYS, excluding Veterans' Affairs hospitals, about nPEP and linkage-to-care protocols in the EDs. Basic descriptive statistics were used for analysis. The response rate was 96% (184/191). Of respondents, 88% reported evaluating any patient with a possible nonoccupational exposure to HIV, in accordance with NYS guidelines. Of these, 83% provided the patient with a starter pack of medications, while 4% neither supplied nor prescribed antiretroviral drugs in the ED. Sexually transmitted infection screening, risk reduction counseling, and education about symptoms of acute HIV seroconversion were performed inconsistently, despite NYS guidelines recommendations. Only 22% of EDs confirmed whether linkage to follow-up care was successful. Most NYS EDs prescribe nPEP to appropriate patients but full implementation of guidelines remains incomplete.
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Affiliation(s)
| | - Daniel J Egan
- Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | - Ethan Cowan
- Department of Emergency Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Leah M Savitsky
- New York State Department of Health, AIDS Institute, New York, NY, USA
| | - John D Kushner
- New York State Department of Health, AIDS Institute, New York, NY, USA
| | - Yvette Calderon
- Department of Emergency Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bruce D Agins
- New York State Department of Health, AIDS Institute, New York, NY, USA
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